Occupational ultraviolet light exposure increases the risk for the development of cutaneous squamous cell carcinoma: a systematic review and meta-analysis

The risky business of being an entomologist: A systematic review

BACKGROUND

Adverse work-related health outcomes are a significant problem worldwide. Entomologists, including arthropod breeders, are a unique occupational group exposed to potentially harmful arthropods, pesticides, and other more generic hazards. These exposures may place them at risk of a range of adverse work-related health outcomes.

OBJECTIVES

To determine what adverse work-related health outcomes entomologists have experienced, the incidence/prevalence of these outcomes, and what occupational management strategies have been employed by entomologists, and their effectiveness.

METHODS

A systematic search of eight databases was undertaken to identify studies informing the review objectives. Data pertaining to country, year, design, work-exposure, adverse work-related health outcomes, incidence/prevalence of these outcomes, and occupational management strategies were extracted, and reported descriptively.

DISCUSSION

Results showed entomologists experienced work-related allergies, venom reactions, infections, infestations and delusional parasitosis. These related to exposure to insects, arachnids, chilopods and entognathans, and non-arthropod exposures, e.g. arthropod feed. Few studies reported the incidence/prevalence of such conditions, or work-related management strategies utilised by entomologists. There were no studies that specifically investigated the effectiveness of potential management strategies for entomologists as a population. Indeed, critical appraisal analysis indicated poor research quality in this area, which is a significant research gap.

CONCLUSIONS

Entomologists are a diverse, unique occupational group, at risk of a range of adverse work-related health outcomes. This study represents the first systematic review of their work-related health risks. Future studies investigating the prevalence of adverse work-related health outcomes for entomologists, and the effectiveness of management strategies are warranted to decrease the disease burden of this otherwise understudied group.

Concise Review: Using Stem Cells to Prevent the Progression of Myopia-A Concept

The prevalence of myopia has increased in modern society due to the educational load of children. This condition is growing rapidly, especially in Asian countries where it has already reached a pandemic level. Typically, the younger the child's age at the onset of myopia, the more rapidly the condition will progress and the greater the likelihood that it will develop the known sight-threatening complications of high myopia. This rise in incidence of severe myopia has contributed to an increased frequency of eye diseases in adulthood, which often complicate therapeutic procedures. Currently, no treatment is available to prevent myopia progression. Stem cell therapy can potentially address two components of myopia. Regardless of the exact etiology, myopia is always associated with scleral weakness. In this context, a strategy aimed at scleral reinforcement by transplanting connective tissue-supportive mesenchymal stem cells is an attractive approach that could yield effective and universal therapy. Sunlight exposure appears to have a protective effect against myopia. It is postulated that this effect is mediated via local ocular production of dopamine. With a variety of dopamine-producing cells already available for the treatment of Parkinson's disease, stem cells engineered for dopamine production could be used for the treatment of myopia. In this review, we further explore these concepts and present evidence from the literature to support the use of stem cell therapy for the treatment of myopia.

Incidence and prevalence of non-melanoma skin cancer in Australia: A systematic review

Non-melanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is the most common cancer occurring in people with fair skin. Australia has been reported to have the highest incidence of NMSC in the world. Using a systematic search of the literature in EMBASE and Medline, we identified 21 studies that investigated the incidence or prevalence of NMSC in Australia. Studies published between 1948 and 2011 were identified and included in the analysis. There were six studies that were conducted on national level, two at state level and 13 at the regional level. Overall, the incidence of NMSC had steadily increased over calendar-years in Australia. The incidence of NMSC per 100,000 person-years was estimated to be 555 in 1985; 977 in 1990; 1109 in 1995; 1170 in 2002 and 2448 in 2011. The incidence was higher for men than women and higher for BCC than SCC. Incidence varied across the states of Australia, with the highest in Queensland. The prevalence of NMSC was estimated to be 2% in Australia in 2002. The incidence and prevalence of NMSC still need to be accurately established at both national and state levels to determine the costs and burden of the disease on the public health system in Australia.

Photocarcinogenesis: an epidemiologic perspective on ultraviolet light and skin cancer

Photocarcinogenesis is the result of a complex interplay between ultraviolet radiation, DNA damage, mutation formation, DNA repair, apoptosis, and the immune system. Recent trends show an increase in incidence of both melanoma and nonmelanoma skin cancers. Some individuals have a genetic predisposition toward increased risk for skin cancer, whereas others experience increased risk through ultraviolet exposure and subsequent mutation formation. The initiation and propagation pathways of melanoma and nonmelanoma skin cancers differ but have some elements in common. The increase in incidence of skin cancer has been discovered to vary among age groups and gender.

Occupational skin cancer due to UV-irradiation--Analyses of notified cases as "virtually-certain" occupational disease in Germany between 2005 and 2011

BACKGROUND

UV-induced skin cancer is not yet included in the German ordinance on occupational diseases and can only be notified and recognized acknowledged as "virtually-certain" occupational disease. The objective of the study was to analyze notified and acknowledged cases of occupational skin cancer due to UV-irradiation in Germany between 2005 and 2011.

PATIENTS AND METHODS

All notified cases of occupational skin cancer due to UV-irradiation have been analyzed which have been registered by the German Statutory accident insurance as of May 2012 were analyzed. The data analyze was descriptive stratified annually for presenting time trends.Data analysis was descriptive, stratified by year to defect time trends.

RESULTS

Notified cases have increased annually with a total of 548 registered cases of occupational skin cancer induced by UV-irradiation between 2005 and 2011, and 74 recognized acknowledged cases. In 56 cases the procedure was not yet finished. Squamous cell carcinoma (SCC) and in-situ squamous cell carcinoma (actinic keratosis, Bowen's disease) were most frequent and have been the most frequentlyobserved in 333 notified cases. and between 15.6 % and 24.9 % have been recognizedof cases with SCC and actinic keratosis were recognized, respectively. 184 patients with basal cell carcinoma were notified but only 6.5 % recognized acknowledged and only 3 cases with exclusive basal cell carcinoma. Out of 50 notified patients with Mmelanoma only one was recognizedacknowledged.

CONCLUSIONS

The results are in good agreement with the proposal of the German Minister of labor to establish UV-induced skin cancer as a new occupational disease.

Artocarpin Induces Apoptosis in Human Cutaneous Squamous Cell Carcinoma HSC-1 Cells and Its Cytotoxic Activity Is Dependent on Protein-Nutrient Concentration

Artocarpin, a natural prenylated flavonoid, has been shown to have various biological properties. However, its effects on human cutaneous squamous cell carcinoma (SCC) have not been previously investigated. We set out to determine whether artocarpin has cytotoxic effects on SCC cells and whether its pharmacological activity is dependent on protein-nutrient concentration. Our results showed that treatment of HSC-1 cells (a human cutaneous SCC cell line) with artocarpin decreased cell viability and induced cell apoptosis by increasing caspase 3/7 activity. These effects were more pronounced at low fetal bovine serum (FBS) concentrations. Artocarpin induced an increase in the level of phospho-p38 and a decrease in the levels of phospho-ERK, phospho-JNK, phospho-Akt, phospho-mTOR, and phospho-S6K. High FBS concentrations in the culture media inhibited and delayed the uptake of artocarpin from the extracellular compartment (culture media) into the intracellular compartment, as determined by high performance liquid chromatography (HPLC) analysis. In conclusion, artocarpin induces apoptosis in HSC-1 cells through modulation of MAPK and Akt/mTOR pathways. Binding of artocarpin to proteins in the FBS may inhibit cellular uptake and reduce the cytotoxic activity of artocarpin on HSC-1 cells. Therefore, artocarpin may have potential use in the future as a form of treatment for cutaneous SCC.

A general model to predict individual exposure to solar UV by using ambient irradiance data

Excessive exposure to solar ultraviolet (UV) is the main cause of skin cancer. Specific prevention should be further developed to target overexposed or highly vulnerable populations. A better characterisation of anatomical UV exposure patterns is however needed for specific prevention. To develop a regression model for predicting the UV exposure ratio (ER, ratio between the anatomical dose and the corresponding ground level dose) for each body site without requiring individual measurements. A 3D numeric model (SimUVEx) was used to compute ER for various body sites and postures. A multiple fractional polynomial regression analysis was performed to identify predictors of ER. The regression model used simulation data and its performance was tested on an independent data set. Two input variables were sufficient to explain ER: the cosine of the maximal daily solar zenith angle and the fraction of the sky visible from the body site. The regression model was in good agreement with the simulated data ER (R(2)=0.988). Relative errors up to +20% and -10% were found in daily doses predictions, whereas an average relative error of only 2.4% (-0.03% to 5.4%) was found in yearly dose predictions. The regression model predicts accurately ER and UV doses on the basis of readily available data such as global UV erythemal irradiance measured at ground surface stations or inferred from satellite information. It renders the development of exposure data on a wide temporal and geographical scale possible and opens broad perspectives for epidemiological studies and skin cancer prevention.

The potential impact of climate change and ultraviolet radiation on vaccine-preventable infectious diseases and immunization service delivery system

Climate change and solar ultraviolet radiation may affect vaccine-preventable infectious diseases (VPID), the human immune response process and the immunization service delivery system. We systematically reviewed the scientific literature and identified 37 relevant publications. Our study shows that climate variability and ultraviolet radiation may potentially affect VPID and the immunization delivery system through modulating vector reproduction and vaccination effectiveness, possibly influencing human immune response systems to the vaccination, and disturbing immunization service delivery. Further research is needed to determine these affects on climate-sensitive VPID and on human immune response to common vaccines. Such research will facilitate the development and delivery of optimal vaccination programs for target populations, to meet the goal of disease control and elimination.

Actinic keratoses - a systemic review

Mainly elderly people with pale skin are affected by actinic keratoses (AK). Due to the demographic change, the prevalence of AK increased over the last years. An established risk factor is chronic UV-exposure (outdoor workers) inducing mutations of the tumor suppressor gene TP53 and the oncogene H-Ras. This leads to an intraepidermal proliferation of atypical keratinocytes. The term “field cancerization” characterises the presentation of multiple AK in UV-exposed areas. AK are also termed squamous cell carcinoma (SCC) in situ. The risk for AK turning into a SCC is 6-10%. In order to avoid invasive growth, an early treatment is recommended. During the last years multiple therapeutic options have been established. Depending on the clinical extent, lesion- or field-directed therapies with excellent clinical response and cosmetic results are available.

Tomotherapy concomitant with cetuximab, followed by cetuximab as single-agent therapy for unresectable squamous cell carcinoma of the skin: a case report

BACKGROUND

Cutaneous squamous cell carcinoma (SCC) is the second most frequency of all skin tumors. Incidence of SCC has risen significantly due to an increased sun exposure and the number of immunodeficient patients. Cutaneous SCC is characterized by high Epidermal growth factor receptor (EGFR) expression with low frequency of RAS mutations. Generally, locoregional surgery is curative and systemic therapy is not indicated. We evaluated the activity and toxicity profile of tomotherapy concomitant with Cetuximab, followed by Cetuximab as single agent therapy in a patient affected by unresectable, locally advanced cutaneous SCC.

CASE PRESENTATION

At our institution, on March 2012 we treated a 45 years-old patient affected by locally advanced, unresectable G1 SCC of the lumbar region. At our first observation, the patient was asthenic, with severe pain and functional limitations. There was also a superinfection due to Pseudomonas Aeruginosa resistant to antibiotics, and a G3 anemia secondary to the bleeding lesion. ECOG Performance Status was 2. Tomotherapy has been performed concomitant with the Cetuximab (400 mg/m2, followed by weekly doses of 250 mg/m2) at the total dose of 60 Gy (2 Gy/fx), followed by Cetuximab monotherapy.The lesion reduced progressively until disappear even after the suspension of the treatment and the patient achieved complete response. Toxicity resulted in G1 cutaneous rash and G2 toxicity to the nails, appeared after 5 months of treatment, typical toxicity profile of the anti-EGFR therapies. After one month of therapy the Pseudomonas Aeruginosa superinfection totally disappeared. Quality of life resulted significantly improved with reduction until discontinuation of the anti-pain drugs, and progressive increase of the hemoglobin levels. At follow up of 15 months there was no evidence of active disease and the ECOG Performance Status was 0 (zero).

CONCLUSION

The treatment was effective and feasible. Considering these excellent results, further studies about concomitant tomotherapy with Cetuximab for advanced/inoperable SCC of the skin are needed.

Skin health in older age

As people age, their skin undergoes changes which result in reduced elasticity, increased fragility and an altered immune response; in essence it becomes frail. As life expectancy is increasing the health of older skin is becoming a progressively more important facet of overall care. In addition to the consequences of ageing for otherwise healthy skin, the relative incidence of some dermatological conditions is age-dependent. In particular, xerosis (dry skin), cutaneous malignancies and skin injuries are more common in older people. In this review we describe the functional consequences of skin ageing and discuss the current evidence on how skin health may be maintained and dermatological conditions prevented in an ageing population. The future of dermatological health-care provision in the older population relies on the development of coordinated pathways of care, which start from a young age. Better quality research coordinated by the establishment of institutions dealing with skin health and ageing would be a method of addressing these needs.

Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: a comprehensive review and meta-analysis

Vitamin D is formed mainly in the skin upon exposure to sunlight and can as well be taken orally with food or through supplements. While sun exposure is a known risk factor for skin cancer development, vitamin D exerts anti-proliferative and pro-apoptotic effects on melanocytes and keratinocytes in vitro. To clarify the role of vitamin D in skin carcinogenesis, we performed a review of the literature and meta-analysis to evaluate the association of vitamin D serum levels and dietary intake with cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) risk and melanoma prognostic factors. Twenty papers were included for an overall 1420 CM and 2317 NMSC. The summary relative risks (SRRs) from random effects models for the association of highest versus lowest vitamin D serum levels was 1.46 (95% confidence interval (CI) 0.60-3.53) and 1.64 (95% CI 1.02-2.65) for CM and NMSC, respectively. The SRR for the highest versus lowest quintile of vitamin D intake was 0.86 (95% CI 0.63-1.13) for CM and 1.03 (95% CI 0.95-1.13) for NMSC. Data were suggestive of an inverse association between vitamin D blood levels and CM thickness at diagnosis. Further research is needed to investigate the effect of vitamin D on skin cancer risk in populations with different exposure to sunlight and dietary habits, and to evaluate whether vitamin D supplementation is effective in improving CM survival.

Skin cancer - an overview for dentists

Skin cancer is common and an increasing problem in the UK. It frequently occurs on the head and neck skin. A significant proportion of the adult population in the UK visits the dentist each year, thus making dental practitioners ideally placed to identify suspicious lesions, which could be skin cancer, as part of their routine extra-oral examination. These patients can then be referred on to hospital or their GP for further management. The dentist can also give advice on risk factors and self-monitoring to patients. This paper aims to describe the risk factors, pathology, presentation and treatments for the three most common forms of skin cancer - basal and squamous cell carcinomas, and malignant melanoma, to give the dental practitioner the knowledge and confidence to examine for and identify these skin cancers.

Evaluation of occupational cold environments: field measurements and subjective analysis

The present work is dedicated to the study of occupational cold environments in food distribution industrial units. Field measurements and a subjective assessment based on an individual questionnaire were considered. The survey was carried out in 5 Portuguese companies. The field measurements include 26 workplaces, while a sample of 160 responses was considered for the subjective assessment. In order to characterize the level of cold exposure, the Required Clothing Insulation Index (IREQ) was adopted. The IREQ index highlights that in the majority of the workplaces the clothing ensembles worn are inadequate, namely in the freezing chambers where the protection provided by clothing is always insufficient. The questionnaires results show that the food distribution sector is characterized by a female population (70.6%), by a young work force (60.7% are less than 35 yr old) and by a population with a medium-length professional career (80.1% in this occupation for less than 10 yr). The incidence of health effects which is higher among women, the distribution of protective clothing (50.0% of the workers indicate one garment) and the significant percentage of workers (>75%) that has more difficulties in performing the activity during the winter represent other important results of the present study.

Ultraviolet radiation and the athlete: risk, sun safety, and barriers to implementation of protective strategies

Ultraviolet (UV) radiation plays a pivotal role in the development of both melanoma and non-melanoma skin cancers. Numerous factors potentially place athletes at high risk for developing these cancers. Various prevention strategies ameliorate this risk, including avoiding sun exposure during peak UV exposure hours, applying sunscreen with a sun protection factor of 30 or above before participating in outdoor sports, wearing hats and sunglasses, and reducing exposure with long pants and long-sleeve shirts. The literature, however, cites several barriers to these prevention approaches, including sports' competition rules, the lack of availability of sunscreen, and the lack of information about sun safety behaviors. Sun safety education programs prove effective in getting athletes to participate in prevention strategies. This article reviews the effect of UV radiation on athletes' skin and provides sports medicine clinicians with suggestions to improve the sun safety behaviors of their athletes.

Occupational UV exposure of environmental agents in Valencia, Spain

Excessive exposure to ultraviolet radiation (UVR) is considered the most important environmental risk factor in the development of melanoma and skin cancer. Outdoor workers are among those with the highest risk from exposure to solar UVR, as their daily activities constantly expose them to this radiation source. A study was carried out in Valencia, Spain, in summer 2012 and involved a group of 11 workers for a period of six 2-day recordings. Sensitive spore-film filter-type personal dosimeters (VioSpor) were used to measure erythemal UVR received by environmental agents in the course of their daily work. Median 2-day UV exposure was 6.2 standard erythema dose (SED), with 1 SED defined as effective 100 J m(-2) when weighted with the Commission Internationale de L'Eclairage's (CIE) erythemal response function. These workers were found to receive a median of 8.3% total daily ambient ultraviolet erythemal radiation. Comparison with the occupational UV exposure limit showed that the subjects had received an erythemal UV dose in excess of occupational guidelines, indicating that protective measures against this risk are highly advisable.

Actinic keratosis among seafarers

The aim of this study was to assess the prevalence of UV-induced actinic keratosis and further skin lesions. A newly developed questionnaire about lifetime UV radiation exposure was completed by 514 seafarers. An experienced dermatologist inspected the whole-body skin status of all participants. The questionnaire revealed a pre-employment UV radiation exposure in 104 seafarers, sunbed use in 26 subjects and a median work-related UV radiation exposure at sea of 20 years. The diagnosis of actinic keratoses was made in 94 seafarers and the clinical diagnosis of skin cancers in 48 seafarers (28 basal cell carcinoma, 11 squamous cell carcinoma, 9 malignant melanoma). After age standardisation according to a European reference population, the male European seafarers in this study had a 1.80-fold increased risk of actinic keratosis. Actinic keratoses [OR 1.03 (1.01-1.05)] and squamous cell carcinoma [OR 1.07 (1.01-1.13)] were related to the duration of seafaring time in years. A significant association was also found between actinic keratosis/squamous cell carcinoma and sunlight exposure during home leave [OR 1.67 (1.03-2.81) and OR 6.19 (1.18-32.40)]. Furthermore, the engine room personnel-especially the technical officers-were at higher risk of developing actinic keratosis. Due to the high prevalence of actinic keratosis especially among older seafarers with fair skin, with longer duration of seafaring employment at sea and with higher UV exposure during home leave, more intensive advice should be given on sun protection both at sea and ashore.

Risk factors for squamous cell carcinoma, a study by the National Dermatology Centre of Colombia

INTRODUCTION

Nonmelanoma skin cancer is the most common malignancy in white individuals. The risk factors for squamous cell carcinoma, which belongs to the family of nonmelanoma skin cancers, have not been studied in Colombia.

OBJECTIVE

To determine the risk factors for squamous cell carcinoma in patients at a national referral center for skin diseases in Colombia.

MATERIAL AND METHODS

We conducted a case-control study that evaluated sociodemographic, epidemiological, and clinical factors among 332 individuals. Risk was calculated as odds ratio (ORs) using the multivariate conditional logistic regression analysis method.

RESULTS

The following risk factors were identified: family history of skin cancer (OR, 6.55; 95% CI, 1.4-28.9), living in a rural area after the age of 30 years (OR, 3.13; 95% CI, 1.3-7.2), a lifetime working outdoors (OR, 2.98; 95% CI, 1.5-5.7), smoking more than 10 cigarettes a day (OR, 2.96; 95% CI, 1.3-6.5), actinic conjunctivitis (OR, 2.68; 95% CI, 1.2-5.9), poikiloderma of Civatte (OR, 3.29; 95% CI, 1.7-6.1), numerous facial actinic keratoses (OR, 9.23; 95% CI, 4.9-17.1), and numerous freckles (OR, 3.68; 95% CI, 1.3-10.1).

CONCLUSIONS

We have documented clinical characteristics and personal history factors that should guide the physician in making decisions on the preventive and follow-up measures to be adopted for individuals at risk of squamous cell carcinoma. These findings may help guide policy for controlling the disease using local information.

UV-induced occupational skin cancer: possibilities of secondary individual prevention in the "Dermatologist's Procedure"

Invasive squamous cell carcinoma (SCC) as a "quasi occupational disease" according to §9 Section 2 of the German Social Code Book (SGB) VII typically develops on chronically UV-damaged skin from actinic keratoses. After the Medical Scientific Committee of the Federal Ministry of Labor and Social Affairs has confirmed the legal criteria for acknowledging UV-induced SCC as an occupational disease, it is expected that the condition will be added to the official list of occupational diseases issued by the Federal Government in the near future. The Social Accident Insurance is required by law (§3 Occupational Disease Regulation) to prevent these tumors by "all appropriate means". There are excellent therapeutic and preventive measures for the management of actinic keratoses to avoid the development of SCC. The "Dermatologist's Procedure" according to §§ 41-43 of the agreement between the Social Accident Insurance and the Federal Medical Association was established in Germany in 1972 to take preventive measures in insured persons with skin lesions possibly developing into an occupational disease, or worsening it, or leading to a recurrence of it This procedure proved to be very successful in the prevention of severe and/or recurring skin diseases forcing a worker to leave his job. On the basis of this agreement, the Social Accident Insurance has the instruments to independently provide preventive measures for the new occupational skin disease SCC induced by natural UV light according to §9 Section 2 of the German Social Code Book (SGB) VII.

Ultraviolet Radiation and the Skin

Ultraviolet radiation (UVR) has many interactions with the skin, which are explored in detail in this review. Both ultraviolet A (UVA) and ultraviolet B (UVB) wavelengths are absorbed by chromophores in the skin, resulting in important biologic effects. Exposure to UVR can result in sunburn, immediate and delayed skin pigmentation, photoaging, and immunosuppression. In addition, exposure to UVA and UVB is an important risk factor for melanoma, squamous cell carcinoma, and basal cell carcinoma. Because endogenous vitamin D synthesis requires UVB, concerns have been raised about the possibility that photoprotection might contribute to vitamin D deficiency; however, vitamin D supplementation is a safer and more reliable method for maintaining adequate vitamin D levels than UVR exposure. Protection from UVR is critical and involves several factors. These elements include sun avoidance during peak hours of UVR exposure (10 am to 2 pm), proper application of a broad-spectrum sunscreen with adequate sun protection factor, and wearing protective clothing, a wide-brimmed hat, and protective eyewear. Indoor tanning is a high-risk activity that is likely contributing to recent increases in melanoma and nonmelanoma skin cancer in young women, and efforts are ongoing to ban minors from engaging in indoor tanning.

Protein Kinase C ε , Which Is Linked to Ultraviolet Radiation-Induced Development of Squamous Cell Carcinomas, Stimulates Rapid Turnover of Adult Hair Follicle Stem Cells

To find clues about the mechanism by which kinase C epsilon (PKCε) may impart susceptibility to ultraviolet radiation (UVR)-induced development of cutaneous squamous cell carcinomas (SCC), we compared PKCε transgenic (TG) mice and their wild-type (WT) littermates for (1) the effects of UVR exposures on percent of putative hair follicle stem cells (HSCs) and (2) HSCs proliferation. The percent of double HSCs (CD34+ and α6-integrin or CD34+/CD49f+) in the isolated keratinocytes were determined by flow cytometric analysis. Both single and chronic UVR treatments (1.8 kJ/m²) resulted in an increase in the frequency of double positive HSCs in PKCε TG mice as compared to their WT littermates. To determine the rate of proliferation of bulge region stem cells, a 5-bromo-2′-deoxyuridine labeling (BrdU) experiment was performed. In the WT mice, the percent of double positive HSCs retaining BrdU label was 28.4 ± 0.6% compared to 4.0 ± 0.06% for the TG mice, an approximately 7-fold decrease. A comparison of gene expression profiles of FACS sorted double positive HSCs showed increased expression of Pes1, Rad21, Tfdp1 and Cks1b genes in TG mice compared to WT mice. Also, PKCε over expression in mice increased the clonogenicity of isolated keratinocytes, a property commonly ascribed to stem cells.

Occupational exposure to ultraviolet radiation and risk of non-melanoma skin cancer in a multinational European study

Background

Studies suggest that ambient sunlight plays an important role in the pathogenesis of non-melanoma skin cancers (NMSC). However, there is ongoing controversy regarding the relevance of occupational exposure to natural and artificial ultraviolet radiation (UV) radiation.

Objectives

We investigated potential associations between natural and artificial UV radiation exposure at work with NMSC in a case-control study conducted in Hungary, Romania, and Slovakia.

Methods

Occupational exposures were classified by expert assessment for 527 controls and 618 NMSC cases (515 basal cell carcinoma, BCC). Covariate information was collected via interview and multiple logistic regression models were used to assess associations between UV exposure and NMSC.

Results

Lifetime prevalence of occupational exposure in the participants was 13% for natural UV radiation and 7% for artificial UV radiation. Significant negative associations between occupational exposure to natural UV radiation and NMSC were detected for all who had ever been exposed (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.27–0.80); similar results were detected using a semi-quantitative metric of cumulative exposure. The effects were modified by skin complexion, with significantly decreased risks of BCC among participants with light skin complexion. No associations were observed in relation to occupational artificial UV radiation exposure.

Conclusions

The protective effect of occupational exposure to natural UV radiation was unexpected, but limited to light-skinned people, suggesting adequate sun-protection behaviors. Further investigations focusing on variations in the individual genetic susceptibility and potential interactions with environmental and other relevant factors are planned.

Predictors of squamous cell carcinoma in high-risk patients in the VATTC trial

Invasive squamous cell carcinoma (SCC) of the skin is one of the most common cancers in the United States, with no proven means for prevention other than systemic retinoids, which have significant toxicity, and sunscreen. We sought to determine the risk factors for invasive SCC on the face or ears in a high-risk population comprising 1,131 veterans in the Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) Trial. Participants were required to have been diagnosed with at least two keratinocyte carcinomas (KCs) in the 5 years prior to enrollment. The median duration of follow-up was 3.7 years. Twenty-three percent of the participants developed a new invasive SCC, and the cumulative risk of invasive SCC was 30% at 5 years. The following factors independently predicted for new invasive SCCs: number of invasive SCCs and number of in situ SCCs in the 5 years prior to enrollment, actinic keratoses count at enrollment, a history of ever use of topical 5-fluorouracil, and total occupational time spent outdoors. In contrast, the use of angiotensin-convering enzyme inhibitors or angiotensin receptor blockers during the study and a history of warts anywhere on the body were found to protect against new invasive SCCs. These independent predictors remained the same for all SCCs (invasive and in situ combined). The number of basal cell carcinomas in the 5 years prior to enrollment, sunburns, sun sensitivity, and recreational sun exposure were not associated with new SCCs. These findings identify key risk factors for additional SCCs in patients with multiple prior KCs, and suggest that a history of warts may be associated with reduced SCC risk.

Advanced Skin Care - A Novel Ingredient

The skin provides the human body with protection and a major barrier to environmental assault. Caring for skin is sometimes an afterthought. In other words, if something isn't broken, don't fix it. However, in the case of the integument, nothing could be further from the truth. Intact skin is paramount to health and well-being. This article will review skin care, specifically, advanced skin care, uncovering novel ingredients, and their importance for prevention and treatment as well as delving into the caring for the skin from the outside in.

The relationship between occupational sun exposure and non-melanoma skin cancer: clinical basics, epidemiology, occupational disease evaluation, and prevention

BACKGROUND

The cumulative effect of solar ultraviolet (UV) radiation is responsible for the worldwide increase in non-melanoma skin cancer, a category that includes squamous cell carcinoma and its precursors (the actinic keratoses) as well as basal-cell carcinoma. Non-melanoma skin cancer is the most common type of cancer in areas of the world with a light-skinned population. The occupational exposure to UV radiation is high in many outdoor occupations; recent studies suggest that persons working in such occupations are more likely to develop non-melanoma skin cancer.

METHODS

On the basis of a selective review of the literature, we present the current state of knowledge about occupational and non-occupational UV exposure and the findings of meta-analyses on the association of outdoor activity with non-melanoma skin cancer. We also give an overview of the current recommendations for prevention and for medicolegal assessment.

RESULTS

Recent meta-analyses have consistently documented a significantly higher risk of squamous cell carcinoma of the skin among persons who work outdoors (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.40-2.22, p<0.001). There is also evidence for an elevated risk of basal-cell carcinoma (OR 1.43, 95% CI 1.23-1.66, p = 0.0001), but the effect is of lesser magnitude and the study findings are not as uniform.

CONCLUSION

The association of occupational exposure to solar UV radiation with squamous cell carcinoma, including actinic keratosis, has been conclusively demonstrated. It follows that, in Germany, suspected non-melanoma skin cancer in persons with high occupational exposure to UV radiation should be reported as an occupational disease under § 9, paragraph 2 of the Seventh Book of the German Social Code (Sozialgesetzbuch, SGB VII). Preventive measures are urgently needed for persons with high occupational exposure to UV radiation.

Contralateral distribution of nonmelanoma skin cancer between older Hispanic/Latino and non-Hispanic/non-Latino individuals

BACKGROUND

 A recent review of the SEER database revealed that melanoma and Merkel cell carcinoma occur more commonly on the left side of the body. Similarly, a trend was reported in which nonmelanoma skin cancers (NMSCs) were found to be distributed more frequently on the left side of the body.

OBJECTIVES

 To compare the sidedness of NMSC in a large patient population. There were five primary objectives of the present study: (i) to confirm or refute the left-sided trend of NMSC in the largest patient population studied for asymmetry to date; (ii) to determine whether the left-sided trend existed in Hispanic/Latino individuals; (iii) to examine skin cancer in older individuals across ethnicities; (iv) to compare distribution across anatomical location and ethnicity; and (v) to measure gender differences in the distribution of NMSC.

METHODS

 The last 3026 cases referred to the Mohs surgical unit at the University of Miami Miller School of Medicine during 2008-2011 were reviewed. The patient's age, gender, tumour side, tumour type, anatomical location and ethnicity were recorded.

RESULTS

 There were 1505 (50·2%) right-sided tumours and 1495 (49·8%) left-sided tumours (P=0·52). The Hispanic/Latino group had a nonsignificant right-sided trend with 607 (52·7%) right-sided cases and 545 (47·3%) left-sided cases (P=0·06). The non-Hispanic/non-Latino group between the ages of 60 and 85 years had 605 (46·9%) right-sided tumours and 686 (53·1%) left-sided tumours (P=0·024). The Hispanic/Latino group between the ages of 60 and 85 years demonstrated 404 (54·0%) right-sided tumours and 344 (46·0%) left-sided tumours (P=0·028). One hundred and fifty-four skin cancers were located on the upper extremities of non-Hispanic/non-Latino individuals with 64 (41·6%) being right sided and 90 (58·4%) left sided (P=0·036). Seventy-eight skin cancers were located on the upper extremities of Hispanic/Latino individuals with 49 (62·8%) being right sided and 29 (37·2%) left sided (P=0·024). Males had most of the skin cancers at 2125 (70·8%) cases and females had 875 (29·2%) cases (P<0·001).

CONCLUSIONS

 NMSC appears to be more common on the left side of older non-Hispanic/non-Latino individuals, while it is more common on the right side of older Hispanic/Latino individuals. This is likely to be secondary to an environmental factor, such as ultraviolet radiation. NMSC is significantly more common in males relative to females, which may be attributed to differences in gender roles or referral practices.

Cetuximab in non-melanoma skin cancer

INTRODUCTION

Non-melanoma skin cancer (NMSC) has become the most common cancer with squamous cell carcinoma (SCC) as the major cause of morbidity and mortality. REVIEW AREAS COVERED: The chimeric human-mouse monoclonal antibody Cetuximab against epidermal growth factor receptor (EGFR) has been approved for advanced head and neck cancer (HNC). Since SCC has been shown to express the EGFR, EGFR-targeted therapy is an option.

METHODOLOGY

A PUBMED research 2000 - 2012 have been conducted using the following items: "Non-melanoma skin cancer AND cetuximab," "cutaneous squamous cell carcinoma AND cetuximab," and "basal cell carcinoma AND cetuximab."

RESULTS

Current evidence of cetuximab efficacy in NMSC results from a Phase II trial and case reports. Cetuximab can be combined with radiotherapy in analogy to HNC. The total response rate is almost 50% in patients with SCC. The combination with radiotherapy resulted in a complete response rate of 50%. Management of adverse reactions in SCC with particular emphasis on cutaneous toxicities is necessary. Further controlled trials are needed.

EXPERT OPINION

EGFR inhibitor cetuximab is an option for recurrent or advanced SCC of skin. The combination with radiotherapy seems to be superior to cetuximab alone.

Gender bias in skin cancer: role of catalase revealed

Sullivan et al. describe their finding that lower skin catalase activity in male as compared with female mice may be responsible for the increased skin carcinogenesis observed in UVB radiation-exposed male mice. This adds to the growing literature that points toward a gender bias in the pathogenesis of skin cancer. Delineating the events between UV exposure and carcinogenesis in relation to skin's antioxidant activity will provide insight into disease progression, prognosis, and responses to therapy. If substantiated with further studies in humans, this information may aid in designing gender-specific preventive measures aimed at reversing immune suppression through targeting the altered redox status in UV-exposed individuals.

Combined cetuximab and volumetric modulated arc-radiotherapy in advanced recurrent squamous cell carcinoma of the scalp

A 77-year old male patient presented with an ulcerated exophytic tumor (T2, N0, M0) with three macroscopically visible satellite metastases in the right temporo-occipital region. Mohs surgery could not control the disease due to lymphangiosis carcinomatosa and perineural infiltration, and recurrence of satellite skin metastases. Re-staging demonstrated a T2, N1, M0 profile (stage III, AJCC). Chemotherapy was limited by the patient's co-morbidities. Therefore, we used targeted therapy with monoclonal anti-epidermal growth factor receptor antibody cetuximab in combination with volumetric modulated arc- radiotherapy (VMAT). Cetuximab was well tolerated except for the loading dose when the patient developed fever chills. To verify the correct application of VMAT, it was applied to a 3-dimensional measuring phantom prior to the patient's first treatment session. To minimize these tolerances, patient set-up was checked and corrected by orthogonal fluoroscopic images recorded daily by the on-board imager used in our Varian accelerator. The average daily beam time was 6 min (6 arcs, 767 monitor units); the total treatment time including patient set-up and set-up correction was less than 20 min. Combined therapy was well tolerated and complete remission was achieved.