Epidemiology of Skin Cancer: Update 2019

Scalp Reconstruction

This article describes the background and importance of scalp reconstruction. The relevant anatomy and neurovasculature will be discussed. Finally, the entire reconstructive ladder will be examined in its relation to scalp reconstruction and how to optimally reconstruct scalp defects.

Beyond the scoreboard: Coaches' UV-related skin cancer knowledge in outdoor sports

BACKGROUND

The global rise in UV radiation is widely recognized as one of the most relevant health impacts of climate change. Consequently, the prevalence of skin cancer is experiencing a significant increase, with outdoor athletes being identified as a particularly vulnerable population group.

OBJECTIVES

This study aims to investigate the extent of UV-specific skin cancer knowledge among coaches in outdoor sports and to examine potential variations in this knowledge between different sports, coach- and club-specific factors.

METHODS

This nationwide representative study was conducted among outdoor sports coaches from the 10 largest outdoor sports associations in Germany. Their knowledge of the risks associated with UV radiation and prevention measures were evaluated using the Skin Cancer and Sun Knowledge Scale (SCSK Scale).

RESULTS

Out of 1200 participating trainers, the UV-specific skin cancer knowledge score averaged 17.76 (±2.98) on a scale ranging from 0 to 25. The true-false statements 'A tan is a sign that the skin is damaged' (true) and 'When using sunscreen, you can tan without any negative effects' (false) were most frequently answered incorrectly. Only 16% of participants correctly identified basal cell carcinoma as the most prevalent form of skin cancer. Differences in UV-specific skin cancer knowledge were evident across different sports, with football and tennis coaches showing the major knowledge deficits. Conversely, trainers in skiing, swimming and mountain sports demonstrated the highest levels of knowledge. Significant deficiencies in knowledge were particularly notable among male trainers, as well as those from the youngest and the oldest age group, with limited training experience and who primarily worked with children and adolescents in small clubs on a regular basis.

CONCLUSIONS

Serious knowledge deficiencies are evident among German outdoor sports coaches. The study results emphasize the necessity for enhanced coach education and the implementation of evaluated concepts for climate adaptation in sports.

Radiation Therapy in Non-Melanoma Skin Cancers: An Italian Survey on Behalf of the Italian Association of Radiotherapy and Clinical Oncology

AIMS

The National Palliative Care and Interventional Radiotherapy Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) carried out a survey whose aim was to obtain a "snapshot" of the real-world practice of nonmelanoma skin cancer (NMSC) treatments in Italy.

MATERIALS AND METHODS

The survey was conducted on SurveyMonkey's online interface and was sent via e-mail to our society Radiation Oncologists.

RESULTS

Fifty-eight Italian radiation oncologists (ROs), representing 54 centers, answered the survey. Thirteen percent of the ROs declared they treat fewer than 10 NMSC lesions annually, 36% treat between 11 and 20, and 51% treat more than 20 lesions annually. Interventional radiotherapy (IRT) was offered by 25% of the ROs, and every case was reportedly discussed by a multidisciplinary team (71%). Electrons (74%), volumetric modulated arc therapy (V-MAT) (57%), three-dimensional conformal radiotherapy (3D-CRT) (43%), and IRT (26%) were the main treatment options. With external beam radiotherapy (EBRT), 46 and 53 different RT schedules were treated for curative and palliative intent, respectively; whereas for IRT, there were 21 and 7 for curative and palliative intent, respectively. The most popular EBRT curative options were 50-70.95/22-35 fractions (fx) and 50-70 Gy/16-20fx and for EBRT palliative settings, 30Gy/10fx, and 20-35Gy/5fx. For IRT, the most popular curative options were 32-50Gy/8-10fx and 30-54Gy/3-5fx, whereas 30Gy/6fz was the palliative option. Less than 10 re-RT cases were reported in one year in 42.5%, 11-20 cases in 42.5%, and >20 cases annually in 15%. Electrons (61%), VMAT (49%), and BRT (25%) were the most widely used approaches: 20-40Gy in 10fx and 20-25Gy in 5fx were the recommended fractionations.

CONCLUSION

The survey shows a variegated reality. A national registry with more detailed data could help in undercover its causes.

Expression of mast cell tryptase and immunoglobulin E is increased in cutaneous photodamage: implications for carcinogenesis

Purpose: Mast cells, their serine proteinase tryptase, and immunoglobulin E (IgE) can be involved in cutaneous carcinogenesis.Materials and methods: To study the association of tryptase+ and IgE+ cells with photodamage and skin cancers 385 adult patients (201 males, 184 females, 75 with immunosuppression) at risk of any type of skin cancer were examined. Skin biopsies were taken from the sun-protected medial arm and from the photodamaged dorsal forearm skin followed by immunohistochemical staining for tryptase and IgE.Results: The results show that tryptase+ and IgE+ cells are significantly higher in number in the photodamaged than sun-protected skin, both in immunocompetent and -compromised subjects, and there is a strong correlation between tryptase+ and IgE+ cells. The numbers of forearm tryptase+ and especially IgE+ cells associated significantly with the forearm photodamage severity. In the logistic regression analysis, the forearm to upper arm ratio of IgE+ cells produced a univariate odds ratio of 1.521 (p = .010) and a multivariate one of 3.875 (p = .047) for the history of squamous cell carcinoma. The serum level of total IgE correlated significantly to the IgE to tryptase ratio in both skin sites.Conclusions: Therefore, IgE+ mast cells participate in photodamage and carcinogenesis, though it is unclear whether they are tumor-protective or -causative.

Recent advances of injectable in situ-forming hydrogels for preventing postoperative tumor recurrence

The unavoidable residual tumor tissue from surgery and the strong aggressiveness of tumor cells pose challenges to the postoperative treatment of tumor patients, accompanied by in situ tumor recurrence and decreased quality of life. Therefore, there is an urgent need to explore appropriate postoperative therapeutic strategies to remove residual tumor cells after surgery to inhibit tumor recurrence and metastasis after surgery. In recent years, with the rapid development of biomedical materials, the study of local delivery systems as postoperative delivery of therapeutic agents has gradually attracted the attention of researchers. Injectable in situ-forming hydrogel is a locally administered agent injected in situ as a solution that can be loaded with various therapeutic agents and rapidly gels to form a semi-solid gel at the treatment site. This type of hydrogel tightly fills the surgical site and covers irregular excision surfaces. In this paper, we review the recent advances in the application of injectable in situ-forming hydrogels in postoperative therapy, focusing on the matrix materials of this type of hydrogel and its application in the postoperative treatment of different types of tumors, as well as discussing the challenges and prospects of its clinical application.

The Role of Gene Expression Profiling in the Management of Cutaneous Squamous Cell Cancer: A Review

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, with an increasing global incidence. While most cases are successfully treated with surgical excision, a subset can metastasize, leading to significant morbidity and mortality. Current staging systems based on clinical and histopathological features have shown limitations in accurately predicting metastatic risk. This review examines the role of gene expression profiling (GEP), particularly the 40-gene expression profile (40-GEP) test, in improving risk stratification and management of cSCC. We assess the prognostic value of the 40-GEP test, its integration with current staging systems, and its impact on clinical decision-making. Recent studies suggest that incorporating GEP results with traditional staging methods can enhance the identification of high-risk patients, potentially leading to more personalized treatment strategies. The review also explores the challenges of implementing GEP in routine clinical practice, including cost-effectiveness considerations and the need for standardization. Finally, we discuss the implications for future cSCC management and highlight areas for further research. As molecular profiling techniques continue to evolve, GEP represents a promising approach to optimizing care for cSCC patients, aligning with the growing emphasis on personalized medicine in oncology.

Tubulin-Targeted Therapy in Melanoma Increases the Cell Migration Potential by Activation of the Actomyosin Cytoskeleton─An In Vitro Study

One of the most dangerous aspects of cancers is their ability to metastasize, which is the leading cause of death. Hence, it holds significance to develop therapies targeting the eradication of cancer cells in parallel, inhibiting metastases in cells surviving the applied therapy. Here, we focused on two melanoma cell lines─WM35 and WM266-4─representing the less and more invasive melanomas. We investigated the mechanisms of cellular processes regulating the activation of actomyosin as an effect of colchicine treatment. Additionally, we investigated the biophysical aspects of supplement therapy using Rho-associated protein kinase (ROCK) inhibitor (Y-27632) and myosin II inhibitor ((-)-blebbistatin), focusing on the microtubules and actin filaments. We analyzed their effect on the proliferation, migration, and invasiveness of melanoma cells, supported by studies on cytoskeletal architecture using confocal fluorescence microscopy and nanomechanics using atomic force microscopy (AFM) and microconstriction channels. Our results showed that colchicine inhibits the migration of most melanoma cells, while for a small cell population, it paradoxically increases their migration and invasiveness. These changes are also accompanied by the formation of stress fibers, compensating for the loss of microtubules. Simultaneous administration of selected agents led to the inhibition of this compensatory effect. Collectively, our results highlighted that colchicine led to actomyosin activation and increased the level of cancer cell invasiveness. We emphasized that a cellular pathway of Rho-ROCK-dependent actomyosin contraction is responsible for the increased invasive potential of melanoma cells in tubulin-targeted therapy.

Sun exposure and challenges of sun protection in adolescents and young adults: A prevalence observational study

The present study aimed to explore the adherence to and efficiency of skin protection measures among teenagers and young adults. The present study investigated the reasons for sun exposure and the obstacles impeding sun protection. In the summer of 2023, a self-reported questionnaire was posted on the social media account of two high schools, a university, some industrial companies and among the teenage children of a dermatology clinic. Descriptive statistics and multivariate logistic regression analyses were performed to assess the reasons for sun exposure behavior, sun protection measures and the frequency of sunburn among individuals aged 15 to 25 year. A total of 517 young individuals completed the questionnaire. It was found that 43.5% use a hat as a means of sun protection, and only 10% try to limit their exposure to the sun. Nevertheless, 78.7% indicate the use of sun cream, 61.7% expose themselves frequently or very frequently to the sun, and 51.2% exposed themselves to the sun for tanning. Young females were statistically more prone to tan [odds ratio (OR), 2.95; 95% confidence interval (CI), 1.95-4.46] P=0.03 than males. Males exposed themselves to a 3-fold greater extent during recreational activities (OR, 2.98; 95% CI, 1.56-5.69) P=0,025, compared to females. On the whole, the present study demonstrates that young individuals aged 15 to 25 years are exposing themselves too frequently to the sun. A large proportion of individuals still wishes to acquire a tan. Even if the large majority of individuals uses sunscreen, the majority of these do not protect themselves correctly since they report becoming sunburnt frequently.

Risk factors behind the increase of early-onset cancer in Italian adolescents and young adults: An investigation from the Italian AYA Working group

The incidence of early-onset cancers in adolescents and young adults (AYA) has been increasing worldwide since the 1990s. In Italy, a significant increased rate of 1.6 % per year has been reported for early-onset cancers among females between 2008 and 2016. This is mainly attributable to melanoma, thyroid, breast and endometrial cancer. The aim of our work was to describe temporal trends of the main established lifestyle risk factors (tobacco use, alcohol consumption, obesity, physical inactivity, dietary westernization and reproductive factors) over the last 20 years in the Italian AYA population. Available data on behavioural risk factors, individual and household daily life have been obtained and elaborated from PASSI, ISTAT and Eurostat reports. Lowering age of smoking initiation, an increase in alcohol drinkers among young females, and an obesity and overweight epidemic, particularly among children and adolescents as a result of physical inactivity and dietary habits, may be contributing factors behind this cancer epidemic, especially among females. In-depth investigations are needed to understand the exact role of each contributing factor, the effects of exposure to nicotine-containing products and environmental factors such as endocrine disruptors that could play a role in this phenomenon.

Caerin 1.1 and 1.9 peptides halt B16 melanoma metastatic tumours via expanding cDC1 and reprogramming tumour macrophages

BACKGROUND

Cancer immunotherapy, particularly immune checkpoint inhibitors (ICBs) such as anti-PD-1 antibodies, has revolutionised cancer treatment, although response rates vary among patients. Previous studies have demonstrated that caerin 1.1 and 1.9, host-defence peptides from the Australian tree frog, enhance the effectiveness of anti-PD-1 and therapeutic vaccines in a murine TC-1 model by activating tumour-associated macrophages intratumorally.

METHODS

We employed a murine B16 melanoma model to investigate the therapeutic potential of caerin 1.1 and 1.9 in combination with anti-CD47 and a therapeutic vaccine (triple therapy, TT). Tumour growth of caerin-injected primary tumours and distant metastatic tumours was assessed, and survival analysis conducted. Single-cell RNA sequencing (scRNAseq) of CD45+ cells isolated from distant tumours was performed to elucidate changes in the tumour microenvironment induced by TT.

RESULTS

The TT treatment significantly reduced tumour volumes on the treated side compared to untreated and control groups, with notable effects observed by Day 21. Survival analysis indicated extended survival in mice receiving TT, both on the treated and distant sides. scRNAseq revealed a notable expansion of conventional type 1 dendritic cells (cDC1s) and CD4+CD8+ T cells in the TT group. Tumour-associated macrophages in the TT group shifted toward a more immune-responsive M1 phenotype, with enhanced communication observed between cDC1s and CD8+ and CD4+CD25+ T cells. Additionally, TT downregulated M2-like macrophage marker genes, particularly in MHCIIhi and tissue-resident macrophages, suppressing Cd68 and Arg1 expression across all macrophage types. Differential gene expression analysis highlighted pathway alterations, including upregulation of oxidative phosphorylation and MYC target V1 in Arg1hi macrophages, and activation of pro-inflammatory pathways in MHCIIhi and tissue-resident macrophages.

CONCLUSION

Our findings suggest that caerin 1.1 and 1.9, combined with immunotherapy, effectively modulate the tumour microenvironment in primary and secondary tumours, leading to reduced tumour growth and enhanced systemic immunity. Further investigation into these mechanisms could pave the way for improved combination therapies in advanced melanoma treatment.

In vivo CRISPRi screen identified lncRNA portfolio crucial for cutaneous squamous cell carcinoma tumor growth

Cutaneous squamous cell carcinoma (cSCC) accounts for 20% of all skin cancer deaths globally, making it the second-highest subtype of skin cancer. The prevalence of cSCC in humans, as well as the poor capacity for an efficient prognosis, highlights the need to uncover alternative actors and mechanisms at the foundation of skin cancer development. Significant advances have been made to better understand some key factors in cSCC progression. However, little is known about the role of noncoding RNAs, particularly of a specific category called long noncoding RNA (lncRNA). By performing pseudobulk analysis of single-cell sequencing data from normal and cSCC human skin tissues, we determined a global portfolio of lncRNAs specifically expressed in keratinocyte subpopulations. Integration of CRISPR interference screens in vitro and the xenograft model identified several lncRNAs impacting the growth of cSCC cancer lines both in vitro and in vivo. Among these, we further validated LINC00704 and LINC01116 as proliferation-regulating lncRNAs in cSCC lines and potential biomarkers of cSCC progression. Taken together, our study provides a comprehensive signature of lncRNAs with roles in regulating cSCC progression.

Artificial Intelligence-Driven Skin Aging Simulation as a Novel Skin Cancer Prevention

INTRODUCTION

Skin cancer, a prevalent cancer type among fair-skinned patients globally, poses a relevant public health concern due to rising incidence rates. Ultraviolet (UV) radiation poses a major risk factor for skin cancer. However, intentional tanning associated with sunburns remains a common practice, notably among female adults. Appropriate prevention campaigns targeting children and adolescents are needed to improve sun protection behavior particularly in these age groups. The aim of our study was to investigate if an AI-based simulation of facial skin aging can enhance sun protection behavior in female adults.

METHODS

In this single-center, prospective, observational pilot study at Department of Dermatology at the University Hospital of Basel, we took photographs of healthy young females' faces with a VISIA-CR camera (Version 8.2; Canfield Scientific Inc., Parsippany, NJ, USA) between February and March 2021. Digital images were performed in three angles (straight, left 45°, and right 45°). All participants received an AI-based simulation of their facial skin with continuous aging to 80 years. A newly created anonymous questionnaire capturing participants' sociodemographic data and also tanning and sun protection behavior was completed in pre- and post-aging simulation. To observe long-term effects, a 2-year follow-up was conducted between March and April 2023.

RESULTS

The 60 participants (mean age 23.6 ± 2.5 years) evaluated the importance of sun protection significantly higher after skin aging simulation with VISIA-CR camera (p < 0.0001; 95% CI: 8.2-8.8). Post-intervention, 91.7% (55/60) of the females were motivated to reduce UV exposure and to intensify UV protection in the future since the individual UV-dependent risk was perceived significantly higher (p < 0.001; 95% CI: 5.9-6.7). At 2-year follow-up, 96% (24/25) indicated persistent effort reducing UV exposure. The preference for SPF 50+ sunscreen increased to 46.7% (28/65) directly after the skin aging simulation and continued to rise up to 60.0% (15/25) after 2 years.

CONCLUSIONS

Our data emphasize the potential of AI-assisted photoaging interventions to enhance motivation for UV protection in the short and the long term. We encourage that different age and gender groups are addressed in a personalized, generation-specific manner with the appropriate media and by considering the Hawthorne effect. Campaigns with visual AI support can improve the intent of cancer-preventative behavior.

The Expression of miR-211-5p in Sentinel Lymph Node Metastases of Malignant Melanoma Is a Potential Marker for Poor Prognosis

Metastatic primary cutaneous melanoma is a frequently fatal disease despite recent therapeutic advances. Biomarkers to stratify patients' prognosis are lacking. MicroRNAs (miRNAs) are small, non-coding RNAs. We aimed to determine the expression of miR-211-5p in primary tumors and metastases of malignant melanoma and its potential use as a prognostic biomarker. We performed in situ hybridization for miRNA-211-5p on 109 FFPE melanoma samples from 76 patients, including 31 paired primary tumor/metastasis samples. For validation, we performed in silico analyses of TCGA skin cutaneous melanoma (SKCM) cohort. High miR-211-5p expression was more frequent in primary tumors (70.8%) compared to metastases (39.3%). In metastases, it was associated with a significantly worse overall survival. Data from TCGA SKCM cohort confirmed that high miR-211-5p expression in melanoma metastases, but not primary tumors, is associated with worse overall survival. MiR-211-5p expression in metastases is associated with a shorter survival, emphasizing the potential of miR-211-5p as a risk predictor for a less favorable clinical outcome in metastatic disease. In situ hybridization could be implemented in a routine laboratory workflow and can be performed on diagnostic tissue.

Synthesis and Biological Activity Assessment of 2-Styrylbenzothiazoles as Potential Multifunctional Therapeutic Agents

A current trend in healthcare research is to discover multifunctional compounds, able to interact with multiple biological targets, in order to simplify multi-drug therapies and improve patient compliance. The aim of this work was to outline the growing demand for innovative multifunctional compounds, achieved through the synthesis, characterisation and SAR evaluation of a series of 2-styrylbenzothiazole derivatives. The six synthesised compounds were studied for their potential as photoprotective, antioxidant, antiproliferative, and anti-inflammatory agents. In order to profile antioxidant activity against various radical species, in vitro DPPH, FRAP and ORAC assays were performed. UV-filtering activity was studied, first in solution and then in formulation (standard O/W sunscreen containing 3% synthesised molecules) before and after irradiation. Compound BZTst6 proved to be photostable, suitable for broad-spectrum criteria, and is an excellent UVA filter. In terms of antioxidant activity, only compound BZTst4 can be considered a promising candidate, due to the potential of the catechol moiety. Both also showed exceptional inhibitory action against the pro-inflammatory enzyme 5-lipoxygenase (LO), with IC50 values in the sub-micromolar range in both activated neutrophils and under cell-free conditions. The results showed that the compounds under investigation are suitable for multifunctional application purposes, underlining the importance of their chemical scaffolding in terms of different biological behaviours.

Transcriptomic Analysis of Early-Stage Basal Cell Carcinomas in Murine Skin Following Topical Treatments With Ablative Fractional Laser and Vismodegib

Recent studies have demonstrated that ablative fractional laser (AFL) can inhibit the hedgehog pathway, enhance immune infiltration and clear basal cell carcinomas (BCCs) in murine models. In this study, we applied RNA sequencing to further characterise the impact of AFL on the transcriptome of murine skin containing early-stage microscopic BCCs, contrasting it with the effects of topical application of the hedgehog inhibitor vismodegib. Our results showed that BCC induction in murine skin was primarily linked to gene upregulation (significantly upregulated genes: 277, significantly downregulated genes: 24). Characterisation of these genes with Ingenuity Pathway Analysis showed that tumour induction was associated with activation of BCC and Sonic Hedgehog signalling. Both AFL and vismodegib treatments reversed these changes, with vismodegib demonstrating superior performance by reversing most of the upregulated genes (AFL: 59/277; vismodegib: 180/277). Surprisingly, Ingenuity Pathway Analysis also revealed that both AFL and vismodegib treatments caused considerable immune cell infiltration. Based on gene set enrichment analysis and cell type deconvolution, AFL treatment resulted in the largest immune cell recruitment, which for both treatments primarily consisted of infiltrating neutrophils, macrophages and monocytes. In conclusion, the distinct effects observed in BCC skin following AFL and vismodegib treatment suggest key differences between the two interventions. Future applications of AFL or vismodegib treatments could leverage their individual effects, for example by combining the effect of AFL on the immune system with other topical treatments.

Mangiferin: An effective agent against human malignancies

Mangiferin is a bioactive substance present in high concentration in mangoes and also in some other fruits. Owing to its potential as a chemopreventive and chemotherapeutic agent against several types of cancer, this unique, significant, and well-researched polyphenol has received a lot of attention recently. It possesses the ability to treat cancers, including rectal cancer, prostate cancer, ovarian cancer, leukemia, gastric cancer, liver cancer, chronic pancreatitis, and lung cancer. It can control/regulate multiple key signaling pathways, such as signal transducer and activator of transcription 3 (STAT3), second mitochondria-derived activator of caspases/direct inhibitor of apoptosis (IAP)-binding protein with low propidium iodide (pl) (Smac/DIABLO) nuclear factor kappa B (NF-κB), phosphatidylinositol 3 kinase/protein 3 kinase (PI3K/Akt), transforming growth factor beta/suppressor of mothers against decapentaplegic (TGF-β/SMAD), c-jun N-terminal kinase/p38 mitogen-activated protein kinase (JNK/p38-MAPK), and phosphor-I kappa B kinase (p-IκB), which are crucial to the development of cancers. By triggering apoptotic signals and halting the advancement of the cell cycle, it can also prevent some cancer cell types from proliferating and developing. It has been revealed that mangiferin targets a variety of adhesion molecules, cytokines, pro-inflammatory transcription factors, kinases, chemokines, growth factors, and cell-cycle proteins. By means of preventing the onset, advancement, and metastasis of cancer, these targets may mediate the chemopreventive and therapeutic effects of mangiferin. Mangiferin has confirmed potential benefits in lung, cervical, breast, brain, and prostate cancers as well as leukemia whether administered alone or in combination with recognized anticancer compounds. More clinical trials and research investigations are required to completely unleash the potential of mangiferin, which may lower the risk of cancer onset and act as a preventive and therapeutic alternative for a number of cancers.

Facial Reconstruction After Total Resection of Long-Standing Cutaneous Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous non-melanoma cancer in Mexico, accounting for 20% of all skin cancers. It is considered a global public health concern due to the rising incidence and prevalence, which is associated with an aging population. Treatment for cSCC depends on the severity of the disease, which determines different therapeutic approaches. Reconstructive surgery, as a treatment option, has seen significant advancements over the years, offering new opportunities to improve the quality of life for cSCC patients. Modern surgical techniques require both an aesthetic focus and effective reconstruction to meet the desires and expectations of patients. We present the case of a patient with long-standing SCC located in a facial area that is difficult to access for surgical resection and reconstruction, presenting a therapeutic challenge while achieving an aesthetically harmonious scar.

Epidemiology and Screening for Melanoma

Melanoma is the most commonly fatal type of skin cancer, and it is an important and growing public health problem in the United States and worldwide. Fortunately, incidence rates are decreasing in young people, stabilizing in middle-aged people, and increasing in older individuals. Herein, the authors further describe trends in melanoma incidence and mortality, review the literature on risk factors, and provide an up-to-date assessment of population-wide screening and new technology being utilized in melanoma screening.

Photoplethysmography-Based Angiography of Skin Tumors in Arbitrary Areas of Human Body

Noninvasive, rapid, and robust diagnostic techniques for clinical screening of tumors located in arbitrary areas of the human body are in demand. To address this challenge, we analyzed the feasibility of photoplethysmography-based angiography for assessing vascular structures within malignant and benign tumors. The proposed hardware and software were approved in a clinical study involving 30 patients with tumors located in the legs, torso, arms, and head. High-contrast and detailed vessel maps within both benign and malignant tumors were obtained. We demonstrated that capillary maps are consistent and can be interpreted using well-established dermoscopic criteria for vascular morphology. Vessel mapping provides valuable details, which may not be available in dermoscopic images and can aid in determining whether a tumor is benign or malignant. We believe that the proposed approach may become a valuable tool in the preliminary cancer diagnosis and is suitable for large-scale screening.

Immune Checkpoints and Cellular Landscape of the Tumor Microenvironment in Non-Melanoma Skin Cancer (NMSC)

Non-melanoma skin cancer (NMSC) is primarily categorized into basal cell carcinoma (BCC), the most prevalent form of skin cancer, and cutaneous squamous cell carcinoma (cSCC), the second most common type. Both BCC and cSCC represent a significant health burden, particularly in immunocompromised individuals and the elderly. The immune system plays a pivotal role in the development and progression of NMSC, making it a critical focus for therapeutic interventions. This review highlights key immunological targets in BCC and cSCC, with a focus on immune checkpoint molecules such as PD-1/PD-L1 and CTLA-4, which regulate T cell activity and contribute to immune evasion. This review also highlights anti-tumor immune cell subsets within the tumor microenvironment (TME), such as tumor-infiltrating lymphocytes (TILs) and dendritic cells. Additionally, it examines the immunosuppressive elements of the TME, including regulatory T cells (Tregs), myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs), and cancer-associated fibroblasts (CAFs), as well as their roles in NMSC progression and resistance to therapy. Emerging strategies targeting these immune elements, such as monoclonal antibodies, are also discussed for their potential to enhance anti-tumor immune responses and improve clinical outcomes. By elucidating the immunological landscape of BCC and cSCC and drawing comparisons to melanoma, this review highlights the transformative potential of immunotherapy in treating these malignancies.

Evaluation of the Tolerability of Hedgehog Pathway Inhibitors in the Treatment of Advanced Basal Cell Carcinoma: A Narrative Review of Treatment Strategies

Hedgehog pathway inhibitors (HHIs) have broadened the treatment options available for patients with advanced basal cell carcinoma (BCC) for whom traditional therapeutic approaches are not feasible or effective. Sonidegib and vismodegib are oral HHIs that were approved for treatment of patients with advanced BCC after demonstrating promising efficacy in the pivotal Phase II BOLT (NCT01327053) and ERIVANCE (NCT00833417) trials, respectively. However, the incidence and types of treatment-emergent adverse events (AEs) observed with these agents may limit continuous use of HHIs and ultimately impact clinical outcomes. In this review, we summarize the safety and tolerability profiles of sonidegib and vismodegib and discuss potential management strategies for HHI class-effect AEs, including muscle spasms, creatine phosphokinase increase, alopecia, and dysgeusia. These AEs primarily occur early in treatment and can lead to treatment discontinuation. Differences in the pharmacokinetic profiles of sonidegib and vismodegib may contribute to the variability noted in times to onset and resolution of these and other AEs. Evidence suggests that protocol modifications, such as treatment interruptions and dose reductions, are effective ways to manage AEs while maintaining disease control. Nonpharmacologic and pharmacologic interventions may also be considered as part of an AE management strategy. Overall, healthcare providers and patients with advanced BCC should be aware of the HHI class-effect AEs and plan effective management strategies to avoid treatment discontinuation and optimize therapeutic response.

No evidence that retinol is protective for skin cancer

With over 1.5 million new cases annually, skin cancers are the most commonly diagnosed group of cancers worldwide. Among these, melanoma and keratinocyte cancers (KC), comprising squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), are predominant. Retinol, a vitamin A derivative, is essential in the regulation of growth and differentiation of epidermal cells. Moreover, retinol exhibits antioxidant properties, protecting the skin against ultra-violet (UV) radiation induced oxidative damage. Existing research on the impact of retinol on melanoma, SCC and BCC development shows mixed results. Several dietary intake studies have suggested that higher retinol levels reduce skin cancer risk, however, others have failed to find this association. We used two-sample Mendelian randomization (MR) to explore if there is a causal relationship between retinol and the risk of developing melanoma, SCC or BCC. Genetically predicted circulating retinol levels were obtained from a genome wide association study (GWAS) meta-analysis of the INTERVAL (N=11,132) and METSIM (N=6,136) cohorts. Melanoma (30,134 cases and 375,188 controls), SCC (10,557 cases and 537,850 controls) and BCC (36,479 cases and 540,185 controls) risks were derived from published GWAS meta-analyses. We conducted two MR approaches. In the first MR we used a single SNP (rs10882283) that is associated with the levels of Retinol Binding Protein 4 (RBP4) as an instrument variable (IV) for circulating retinol levels. In the second MR we used all independent genetic variants that were strongly associated (P < 5 × 10-8) with retinol levels as IVs. Odds ratios (OR) for skin cancer were calculated for a one standard deviation (SD) increase in genetically predicted retinol levels. The single IV approach revealed that retinol levels were not significantly associated with risk of melanoma (OR = 1.04 [95% confidence interval 0.83, 1.31], P = 0.72), SCC (OR = 1.15 [0.87, 1.51], P = 0.32) or BCC (OR = 1.06 [0.90, 1.23], P = 0.50). Similar null results were observed with the multiple IV approach for melanoma (OR = 1.03 [0.95, 1.11], P = 0.54), SCC (OR = 1.01 [0.91, 1.13], P = 0.83), and BCC (OR = 1.04 [0.96, 1.12], P = 0.38). In conclusion, we found no evidence that circulating retinol levels were causally associated with the development of melanoma, SCC and BCC.

Cutaneous Squamous Cell Carcinoma: From Diagnosis to Follow-Up

Cutaneous squamous cell carcinoma (SCC) is the second most frequent skin cancer, accounting for approximately 20% of all cutaneous malignancies, and with an increasing incidence due to the progressive increment of the average age of life. The diagnosis is usually firstly suspected based on clinical manifestations; however, dermoscopic features may improve diagnostic sensitivity in cases of an uncertain diagnosis and may guide the biopsy, which should be performed to histopathologically prove the tumor. New diagnostic strategies may improve the sensitivity of the cutaneous SCC, such as reflectance confocal microscopy and line-field confocal optical coherence, for which increasing data have been recently published. Imaging has a central role in the staging of the diseases, while its exact role, as well as the choice of the best techniques, during the follow-up are not fully clarified. The aim of this literature review is to describe diagnostic clinical and instrumental tools of cutaneous SCC, with an insight into the role of imaging in the diagnosis and follow-up of cutaneous SCC.

Enhancing Dermatological Diagnostics with EfficientNet: A Deep Learning Approach

Background: Despite recent advancements, medical technology has not yet reached its peak. Precision medicine is growing rapidly, thanks to machine learning breakthroughs powered by increased computational capabilities. This article explores a deep learning application for computer-aided diagnosis in dermatology. Methods: Using a custom model based on EfficientNetB3 and deep learning, we propose an approach for skin lesion classification that offers superior results with smaller, cheaper, and faster inference times compared to other models. The skin images dataset used for this research includes 8222 files selected from the authors' collection and the ISIC 2019 archive, covering six dermatological conditions. Results: The model achieved 95.4% validation accuracy in four categories-melanoma, basal cell carcinoma, benign keratosis-like lesions, and melanocytic nevi-using an average of 1600 images per category. Adding two categories with fewer images (about 700 each)-squamous cell carcinoma and actinic keratoses-reduced the validation accuracy to 88.8%. The model maintained accuracy on new clinical test images taken under the same conditions as the training dataset. Conclusions: The custom model demonstrated excellent performance on the diverse skin lesions dataset, with significant potential for further enhancements.

General practitioners' perspectives on statutory skin cancer screening-A questionnaire-based cross-sectional survey in Germany

BACKGROUND

In Germany, skin cancer screening (SCS) is available free of charge every two years to all those with statutory health insurance over the age of 35. General Practitioners (GP) can carry out the screening if they have completed an 8-hour training course. GPs play a crucial role in the implementation of SCS and act as gatekeepers between initial patient contact and referral to dermatologists.

OBJECTIVE

To record how comprehensively GPs carry out SCS in terms of patient information and body examination, as well as to explore GPs opinions on the feasibility of SCS.

METHODS

A cross-sectional survey was conducted. A questionnaire was sent to GPs with permission to perform SCS in two regions of Germany (Bavaria and Saxony) between August and September 2021. Data were analyzed using descriptive analysis. Subgroup analysis was performed according to regions (federal state, location of physician´s office), professional experience (experience in years, number of monthly screenings, age) and gender. Open questions were evaluated using qualitative content analysis.

RESULTS

In the survey, 204 GPs responded. Genitalia (40.7%, 83/203), anal fold (62.3%, 127/204) and oral mucosa (66.7%, 136/204) were the least examined body regions during screening. Information on risks (false-positive findings: 18.6%, 38/203; false-negative findings: 13.2%, 27/203; overdiagnosis: 7.8%, 16/203) and benefits (48.0%, 98/202) were not always provided. GPs who performed screenings more frequently were more likely to provide information about the benefits of SCS (p<0.001; >10 vs. <5 screenings per month). Opinions were provided on uncertainties, knowledge requirements, structural and organizational requirements of SCS, SCS training and evaluation. The organization and remuneration of the SCS programme was seen as a barrier to implementation. GPs expressed uncertainties especially in unclear findings and in dermatoscopy.

CONCLUSION

Uncertainties in the implementation of the SCS should be addressed by offering refresher courses. Good networking between GPs and dermatologists is essential to improve SCS quality.

Quality of Life in Patients Affected by Facial Basal Cell Carcinoma: Prospective Longitudinal Pilot Study and Validation of Skin Cancer Index in Lithuanian Language

Purpose

Facial basal cell carcinoma (BCC) poses significant challenges due to its potential for local destruction and impact on quality of life (QoL). Continuous research is necessary to identify novel factors influencing the quality of life within this demographic across diverse cultural settings. The aims of this study were to translate, culturally adapt, and validate the Lithuanian version of Skin Cancer Index, subsequently utilizing this questionnaire in the pilot phase of the study to achieve the following: (1) identify the differences in short- and long-term QoL, (2) establish empirical correlations between SCI scores and aesthetic facial regions, evaluate the potential differences between age, gender, and tumor size groups.

Patients and Methods

A prospective longitudinal study was conducted with 100 consecutive patients. The SCI was translated into Lithuanian language, with a rigorous assessment of its psychometric properties to confirm validity. Alongside hypothesis testing, a detailed analysis of variables was conducted. Statistical techniques, including t-tests and ANOVA, were employed to compare scores across demographic and clinical groups, with effect size calculations for further interpretation.

Results

Our findings demonstrate that the Lithuanian SCI successfully fulfills the criteria established by the COSMIN checklist. Surgical treatment for facial BCC notably enhances QoL, particularly evident six months post-surgery. Analysis of SCI scores identified demographic and clinical factors associated with lower QoL, including female gender, treatment with skin plasty, and tumor sites in aesthetically sensitive areas like the cheek, nose, and eyelid.

Conclusion

The Lithuanian version of the SCI is a reliable and valid tool for assessing QoL in facial BCC patients. Our findings underscore the global relevance of understanding the multifactorial influences on QoL in BCC patients. Early diagnosis, less invasive treatment approaches, and tailored post-operative care are crucial in minimizing the psychological, social, and appearance-related burdens of facial BCC.

Sunlight: Time for a Rethink?

UVR is a skin carcinogen, yet no studies link sun exposure to increased all-cause mortality. Epidemiological studies from the United Kingdom and Sweden link sun exposure with reduced all-cause, cardiovascular, and cancer mortality. Vitamin D synthesis is dependent on UVB exposure. Individuals with higher serum levels of vitamin D are healthier in many ways, yet multiple trials of oral vitamin D supplementation show little benefit. Growing evidence shows that sunlight has health benefits through vitamin D-independent pathways, such as photomobilization of nitric oxide from cutaneous stores with reduction in cardiovascular morbidity. Sunlight has important systemic health benefit as well as risks.

Paclitaxel-loaded elastic liposomes synthesised by microfluidics technique for enhance transdermal delivery

The inherent flexibility of elastic liposomes (EL) allows them to penetrate the small skin pores and reach the dermal region, making them an optimum candidate for topical drug delivery. Loading chemotherapy in ELs could improve chemotherapy's topical delivery and localise its effect on skin carcinogenic tissues. Chemotherapy-loaded EL can overcome the limitations of conventional administration of chemotherapies and control the distribution to specific areas of the skin. In the current studies, Paclitaxel was utilised to develop Paclitaxel-loaded EL. As an alternative to the conventional manufacturing methods of EL, this study is one of the novel investigations utilising microfluidic systems to examine the potential to enhance and optimise the quality of Els by the microfluidics method. The primary aim was to achieve EL with a size of < 200 nm, high homogeneity, high encapsulation efficiency, and good stability. A phospholipid (DOPC) combined with neutral and anionic edge activators (Tween 80 and sodium taurocholate hydrate) at various lipid-to-edge activator ratios, was used for the manufacturing of the ELs. A preliminary study was performed to study the size, polydispersity (PDI), and stability to determine the optimum microfluidic parameters and lipid-to-edge activator for paclitaxel encapsulation. Furthermore, physiochemical characterisation was performed on the optimised Paclitaxel-loaded EL using a variety of methods, including Dynamic Light Scattering, Fourier Transform Infrared Spectroscopy, Atomic force microscopy, elasticity, encapsulation efficiency, and In vitro release. The results reveal the microfluidics' significant impact in enhancing the EL characteristics of EL, especially small and controllable size, Low PDI, and high encapsulation efficiency. Moreover, the edge activator type and concentration highly affect the EL characteristics. The Tween 80 formulations with optimised concentration provide the most suitable size and higher encapsulation efficiency. The release profile of the formulations showed more immediate release from the EL with higher edge activator concentration and a higher % of the released dug from the Tween 80 formulations.

The Role of Artificial Intelligence in Early Diagnosis and Molecular Classification of Head and Neck Skin Cancers: A Multidisciplinary Approach

Cancer remains a significant global health concern, with increasing genetic and metabolic irregularities linked to its onset. Among various forms of cancer, skin cancer, including squamous cell carcinoma, basal cell carcinoma, and melanoma, is on the rise worldwide, often triggered by ultraviolet (UV) radiation. The propensity of skin cancer to metastasize highlights the importance of early detection for successful treatment. This narrative review explores the evolving role of artificial intelligence (AI) in diagnosing head and neck skin cancers from both radiological and pathological perspectives. In the past two decades, AI has made remarkable progress in skin cancer research, driven by advances in computational capabilities, digitalization of medical images, and radiomics data. AI has shown significant promise in image-based diagnosis across various medical domains. In dermatology, AI has played a pivotal role in refining diagnostic and treatment strategies, including genomic risk assessment. This technology offers substantial potential to aid primary clinicians in improving patient outcomes. Studies have demonstrated AI's effectiveness in identifying skin lesions, categorizing them, and assessing their malignancy, contributing to earlier interventions and better prognosis. The rising incidence and mortality rates of skin cancer, coupled with the high cost of treatment, emphasize the need for early diagnosis. Further research and integration of AI into clinical practice are warranted to maximize its benefits in skin cancer diagnosis and treatment.

Deep Learning Algorithms for the Detection of Suspicious Pigmented Skin Lesions in Primary Care Settings: A Systematic Review and Meta-Analysis

Early detection of suspicious pigmented skin lesions is crucial for improving the outcomes and survival rates of skin cancers. However, the accuracy of clinical diagnosis by primary care physicians (PCPs) is suboptimal, leading to unnecessary referrals and biopsies. In recent years, deep learning (DL) algorithms have shown promising results in the automated detection and classification of skin lesions. This systematic review and meta-analysis aimed to evaluate the diagnostic performance of DL algorithms for the detection of suspicious pigmented skin lesions in primary care settings. A comprehensive literature search was conducted using electronic databases, including PubMed, Scopus, IEEE Xplore, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. Data from eligible studies were extracted, including study characteristics, sample size, algorithm type, sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and receiver operating characteristic curve analysis. Three studies were included. The results showed that DL algorithms had a high sensitivity (90%, 95% CI: 90-91%) and specificity (85%, 95% CI: 84-86%) for detecting suspicious pigmented skin lesions in primary care settings. Significant heterogeneity was observed in both sensitivity (p = 0.0062, I2 = 80.3%) and specificity (p < 0.001, I2 = 98.8%). The analysis of DOR and PLR further demonstrated the strong diagnostic performance of DL algorithms. The DOR was 26.39, indicating a strong overall diagnostic performance of DL algorithms. The PLR was 4.30, highlighting the ability of these algorithms to influence diagnostic outcomes positively. The NLR was 0.16, indicating that a negative test result decreased the odds of misdiagnosis. The area under the curve of DL algorithms was 0.95, indicating excellent discriminative ability in distinguishing between benign and malignant pigmented skin lesions. DL algorithms have the potential to significantly improve the detection of suspicious pigmented skin lesions in primary care settings. Our analysis showed that DL exhibited promising performance in the early detection of suspicious pigmented skin lesions. However, further studies are needed.

Photoaging and cosmeceutical solutions in sun-overexposed countries: The experience of Australia and Brazil

Skin aging is the result of physiological changes determined by genetically driven processes and intrinsic factors, and exacerbated by a combination of multiple environmental factors, the main one being sun exposure. The effects of photoaging are particularly apparent on the face, where the appearance of aging signs can have a significant impact on the emotions conveyed and well-being. Photoprotection and facial skin care for managing photoaging signs are thus of particular importance for both physical and mental health. Countries, like Australia and Brazil, where the level of sun exposure is high and the populations have predominantly outdoor lifestyles, are particularly aware of the harms of photoaging and have implemented several measures to help reduce the risk of skin cancer in their populations. However, sun-seeking behaviours are difficult to change, and it takes time before interventions provide perceptible results. Australia still has some of the highest skin cancer incidence and mortality rates in the world. Solutions that target individuals can also be used for minimizing the clinical signs of facial aging and for improving skin quality, with the ultimate aim being not only to improve the appearance of the skin but also to mitigate the occurrence of pre-malignant and malignant lesions. This review summarizes the features of facial skin photoaging in photo-exposed populations, based on evidence gained from studies of Australian individuals, and discusses the various available solutions for skin photoaging, in particular those that are most popular in Brazil, which is a country with many years of experience in managing photoaged skin.

Impact of a Youth Sun Safety Educational Program

INTRODUCTION

Sun protection early in life is necessary to prevent skin cancer. Therefore, youth sun safety education is imperative. However, such programs have often failed to bring about behavioral change in youths.

OBJECTIVES

We evaluate a sun safety educational program's effectiveness in improving elementary school students' knowledge of sun safety, confidence in their ability to explain the importance of sun protection, and their understanding of sunscreen labels.

METHODS

A 1.5-hour program was conducted for the fourth-grade students. Forty-five of the 53 students participated in the study and completed the pre- and post-surveys, a response rate of 84%. These surveys were identical, consisting of four questions rated on a Likert scale to assess changes in the students' knowledge, confidence, and understanding regarding sun protection.

RESULTS

The students overall had a statistically significant increase in their knowledge of sun safety and sun protective measures, confidence in their ability to explain the importance of sun protection, and their understanding of sunscreen labels.

CONCLUSIONS

In alignment with the current literature, this study demonstrates the importance of school-based sun safety programs and notably shows that such programs can increase youths' understanding of sunscreen labels and confidence in explaining the importance of sun protection. It is our hope that the program will cause increased practice of sun protective behaviors among the students. Further research is needed to determine how effective such programs are in increasing the practice of sun protective behaviors in youths.

Metastatic cutaneous squamous cell carcinoma accounts for nearly all squamous cell carcinomas of the parotid gland

Primary squamous cell carcinoma of the parotid gland (pSCCP) has long been recognized as a separate entity and is included in the WHO classifications of salivary gland tumors. However, it is widely accepted among head and neck pathologists that pSCCP is exceptionally rare. Yet, there are many publications describing series of pSCCP and data from SEER and other cancer register databases indicate erroneously an increasing incidence of pSCCP. Importantly, pSCCP and metastatic (secondary) squamous cell carcinoma to the parotid gland (mSCCP) have nearly identical histological features, and the diagnosis of pSCCP should only be made after the exclusion of mSCCP. Moreover, all of the histological diagnostic criteria proposed to be in favor of pSCCP (such as, for example, dysplasia of ductal epithelium) can be encountered in unequivocal mSCCP, thereby representing secondary growth along preexistent ducts. Squamous cell differentiation has also been reported in rare genetically defined primary parotid carcinomas, either as unequivocal histological squamous features (e.g., NUT carcinoma, mucoepidermoid carcinoma), by immunohistochemistry (e.g., in NUT carcinoma, adamantinoma-like Ewing sarcoma, basal-type salivary duct carcinoma, mucoepidermoid carcinoma), or a combination of both. Another major issue in this context is that the International Classification of Diseases (ICD) coding system does not distinguish between primary or metastatic disease, resulting in a large number of patients with mSCCP being misclassified as pSCCP. Immunohistochemistry and new molecular biomarkers have significantly improved the accuracy of the diagnosis of many salivary gland neoplasms, but until recently there were no biomarkers that can accurately distinguish between mSCCP and pSCCP. However, recent genomic profiling studies have unequivocally demonstrated that almost all SCCP analyzed to date have an ultraviolet light (UV)-induced mutational signature typical of mSCCP of skin origin. Thus, mutational signature analysis can be a very useful tool in determining the cutaneous origin of these tumors. Additional molecular studies may shed new light on this old diagnostic and clinical problem. This review presents a critical view of head and neck experts on this topic.

Neoadjuvant Immunotherapy in Non-melanoma Skin Cancers of the Head and Neck

OPINION STATEMENT

Neoadjuvant immunotherapy will change the standard of care for advanced resectable cutaneous squamous cell carcinoma (cSCC) and possibly other non-melanoma skin cancers. With pathological complete response rates around 50% for cSCC in early studies, neoadjuvant therapy allows patients the possibility of significant reduction in tumor size, de-escalation of adjuvant therapy, and improved long-term outcomes. Patients must be carefully selected to ensure that there is a margin of safety with respect to resectability, such that if a tumor progresses on neoadjuvant therapy, there remains a curative surgical option that is acceptable to the patient. The optimal treatment paradigm is an area of active research, with many researchers questioning whether adjuvant therapy, or even local therapy, is necessary in patients who seem to have a complete response. The ability to predict who will respond will become even more critical to answer, as a significant number of patients do not want to risk their disease progressing, especially in cosmetically sensitive areas of the head and neck. Recent studies in melanoma show promise for improved response rates using combination therapies, and these strategies may apply to cSCC as well. The use of LAG-3 inhibitors or mRNA vaccine technology may further improve the utility of neoadjuvant strategies.

Protective Effect of Red Light-Emitting Diode against UV-B Radiation-Induced Skin Damage in SKH:HR-2 Hairless Mice

In this in vivo study on hairless mice, we examined the effects of light-emitting diode (LED) treatment applied prior to ultraviolet B (UVB) irradiation. We found that pre-treating with LED improved skin morphological and histopathological conditions compared to those only exposed to UVB irradiation. In our study, histological evaluation of collagen and elastic fibers after LED treatment prior to UVB irradiation showed that this pretreatment significantly enhanced the quality of fibers, which were otherwise poor in density and irregularly arranged due to UV exposure alone. This suggests that LED treatment promotes collagen and elastin production, leading to improved skin properties. Additionally, we observed an increase in Claudin-1 expression and a reduction in nuclear factor-erythroid 2-related factor 2 (Nrf-2) and heme-oxygenase 1 (HO-1) expression within the LED-treated skin tissues, suggesting that LED therapy may modulate key skin barrier proteins and oxidative stress markers. These results demonstrate that pretreatment with LED light can enhance the skin's resistance to UVB-induced damage by modulating gene regulation associated with skin protection. Further investigations are needed to explore the broader biological effects of LED therapy on other tissues such as blood vessels. This study underscores the potential of LED therapy as a non-invasive approach to enhance skin repair and counteract the effects of photoaging caused by UV exposure.

Representation of skin carcinomas in public awareness - Awareness worldwide and in Germany

BACKGROUND AND OBJECTIVES

In recent years, there has been an increase in skin cancer. The aim of this study was therefore to investigate the representation of skin cancer in public awareness worldwide and in Germany, and to determine whether Skin Cancer Awareness Month is represented in the search interests of the Internet-using population in the same way as Breast Cancer Awareness Month worldwide.

DATA AND METHODS

In this study, Google Trends data were used to track levels of public awareness for different tumor entities and skin cancer types worldwide and for Germany.

RESULTS

The results of this analysis clearly showed a high level of relative public search interest in breast cancer worldwide in the awareness month of October. Worldwide and in Germany, there was a certain increase in search interest and a certain seasonal effect around the May awareness month for skin cancer. For example, the analysis showed a search interest in May and during the summer months in Germany.

CONCLUSIONS

It is likely that the population, for example in Germany, may benefit further from an even greater emphasis on the topic of skin cancer.

Vesicular approach of cubosomes, its components, preparation techniques, evaluation and their appraisal for targeting cancer cells

Cancer has been characterized by abnormal and uncontrolled proliferation of cells. Majority of drugs given through chemotherapy produce unwanted and adverse effects of chemotherapeutic agents to the other healthy cells and tissues of body. Various nanocarriers have now been considered for treatment of cancer. Among various nanocarriers, cubosomes are the nano sized dispersions that have drawn interest of researchers recently. Cubosomes are defined as dispersions of colloidal nature containing cubic crystalline liquid formations in aqueous medium in presence of suitable surfactant molecules. The unique capacity to encapsulate lipophilic, hydrophilic, and amphiphilic compounds inside their structure distinguishes them among others. Top- down method and hydrotrope method are most often employed methods for cubosomes preparation. Cubosomes can be characterized by Polarized light microscopy Photon correlation spectroscopy X-ray scattering (SAXS), Transmission electron microscopy and various stability studies. Cubic lipid nanoparticles have a very stable cubic structure that enables slower dissociation rate, increased retention and site-specific delivery of drugs. Cubosomes containing extracts of cornelian cherry for boosting anti-cancerous effects in cancer of colorectal cells by preventing against GIT destruction. When applied for skin cancer, cubosomes have shown to be having enhanced permeation of the drug. In liver cancer, increased bioavailability of drug was observed via cubosomes. This current review elaborates the advancement of cubosomes and their effective role in the treatment of cancer. This review aims to describe vesicular approach of cubosomes, its composition and method of preparation, characterization tests as well as elaborates various applications of cubosomes in cancer.

Repräsentation von Hautkarzinomen im öffentlichen Bewusstsein – Aufmerksamkeit weltweit und in Deutschland

Hintergrund und Zielsetzung

In den letzten Jahren ist eine Zunahme von Hauttumoren zu verzeichnen. Ziel dieser Studie war es daher, die Repräsentation von Hautkrebs im öffentlichen Bewusstsein weltweit und in Deutschland zu untersuchen und festzustellen, ob der Skin Cancer Awareness Month in den Suchinteressen der internetnutzenden Bevölkerung in gleicher Weise wie der Breast Cancer Awareness Month weltweit repräsentiert ist.

Daten und Methodik

In dieser Studie wurden die Daten von Google Trends verwendet, um den Grad der öffentlichen Aufmerksamkeit für verschiedene Tumorentitäten und Hautkrebsarten weltweit und in Deutschland zu ermitteln.

Ergebnisse

Die Ergebnisse dieser Analyse zeigten deutlich ein hohes Niveau für das relative öffentliche Suchinteresse am Thema Brustkrebs weltweit im Sensibilisierungsmonat Oktober. Weltweit und in Deutschland war ein gewisser Anstieg des Suchinteresses beziehungsweise ein gewisser saisonaler Effekt um den Sensibilisierungsmonat Mai für Hautkrebs festzustellen. So zeigte die Analyse beispielsweise ein Suchinteresse im Mai und während der Sommermonate in Deutschland.

Schlussfolgerungen

Es ist wahrscheinlich, dass die Bevölkerung, zum Beispiel in Deutschland, weiterhin von einer noch stärkeren Betonung des Themas Hautkrebs profitieren könnte.

Melanoma prevention using an augmented reality-based serious game

OBJECTIVES

The purpose of this study was to field-test a recently developed AR-based serious game designed to promote SSE self-efficacy, called Spot.

METHODS

Thirty participants played the game and answered 3 questionnaires: a baseline questionnaire, a second questionnaire immediately after playing the game, and a third questionnaire 1 week later (follow-up).

RESULTS

The majority of participants considered that the objective quality of the game was high, and considered that the game could have a real impact in SSE promotion. Participants showed statistically significant increases in SSE self-efficacy and intention at follow-up. Of the 24 participants that had never performed a SSE or had done one more than 3 months ago, 12 (50.0%) reported doing a SSE at follow-up.

CONCLUSIONS

This study provides supporting evidence to the use of serious games in combination with AR to educate and motivate users to perform SSE. Spot seems to be an inconspicuous but effective strategy to promote SSE, a cancer prevention behavior, among healthy individuals.

PRACTICE IMPLICATIONS

Patient education is essential to tackle skin cancer, particularly melanoma. Serious games, such as Spot, have the ability to effectively educate and motivate patients to perform a cancer prevention behavior.

Is diet related to skin condition? A Mendelian randomization study

Observational studies have revealed associations between various dietary factors and skin conditions. However, the causal relationship between diet and skin condition is still unknown. Data on 17 dietary factors were obtained from the UK Biobank. Data on four skin conditions were derived from the UK Biobank and another large-scale GWAS study. Genetic predictions suggested that the intake of oily fish was associated with a lower risk of skin aging (OR: 0.962, P = 0.036) and skin pigmentation (OR: 0.973, P = 0.033); Tea intake was associated with a lower risk of skin pigmentation (OR: 0.972, P = 0.024); Salad/raw vegetables intake was associated with a lower risk of keratinocyte skin cancer (OR: 0.952, P = 0.007). Coffee intake was associated with increased risk of skin aging (OR: 1.040, P = 0.028); Pork intake was associated with increased risk of skin aging (OR: 1.134, P = 0.020); Beef intake was associated with increased risk of cutaneous melanoma (OR: 1.013, P = 0.016); Champagne plus white wine intake was associated with increased risk of cutaneous melanoma (OR: 1.033, P = 0.004); Bread intake was associated with increased risk of keratinocyte skin cancer (OR: 1.026, P = 0.013). Our study results indicate causal relationships between genetically predicted intake of oily fish, tea, salad/raw vegetables, coffee, pork, beef, champagne plus white wine, and bread and skin conditions.

Multimodal MALDI imaging mass spectrometry for improved diagnosis of melanoma

Imaging mass spectrometry (IMS) provides promising avenues to augment histopathological investigation with rich spatio-molecular information. We have previously developed a classification model to differentiate melanoma from nevi lesions based on IMS protein data, a task that is challenging solely by histopathologic evaluation. Most IMS-focused studies collect microscopy in tandem with IMS data, but this microscopy data is generally omitted in downstream data analysis. Microscopy, nevertheless, forms the basis for traditional histopathology and thus contains invaluable morphological information. In this work, we developed a multimodal classification pipeline that uses deep learning, in the form of a pre-trained artificial neural network, to extract the meaningful morphological features from histopathological images, and combine it with the IMS data. To test whether this deep learning-based classification strategy can improve on our previous results in classification of melanocytic neoplasia, we utilized MALDI IMS data with collected serial H&E stained sections for 331 patients, and compared this multimodal classification pipeline to classifiers using either exclusively microscopy or IMS data. The multimodal pipeline achieved the best performance, with ROC-AUCs of 0.968 vs. 0.938 vs. 0.931 for the multimodal, unimodal microscopy and unimodal IMS pipelines respectively. Due to the use of a pre-trained network to perform the morphological feature extraction, this pipeline does not require any training on large amounts of microscopy data. As such, this framework can be readily applied to improve classification performance in other experimental settings where microscopy data is acquired in tandem with IMS experiments.

Aesthetic Evaluation of Facial Scars in Patients Undergoing Surgery for Basal Cell Carcinoma: A Prospective Longitudinal Pilot Study and Validation of POSAS 2.0 in the Lithuanian Language

Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region.

Assessment of prevalence of sunscreen use and related practices among people living in Saudi Arabia: A cross-sectional survey-based study

BACKGROUND

The use of sunscreen significantly reduces the risk of skin cancer and helps maintain skin health; however, improper use can decrease its effectiveness. This study aimed to investigate the prevalence and factors associated with sunscreen use in Saudi Arabia as well as identifying areas of weakness in sunscreen practices.

METHODS

A cross-sectional survey-based study was conducted with a diverse population sample in Saudi Arabia. Participants were asked about their sunscreen usage habits, motivations, and knowledge of proper application techniques. Demographic information, including age, gender, and skin type, were also collected.

RESULTS

A total of 2321 individuals participated in the study. More than two-thirds of the participants reported using sunscreen either always, regularly, or often, primarily to maintain a light skin color and prevent skin cancer. Factors associated with sunscreen use included younger age (18-40 years old), female gender, history of sunburn, and fair skin. Despite the majority reporting healthy sun exposure habits, several shortcomings were identified in sunscreen practices, including incorrect application and suboptimal reapplication frequency.

CONCLUSION

While sunscreen use is common among the study population, there is a need for improved education on proper application techniques. National awareness campaigns, especially those utilizing popular social media and digital platforms in Saudi Arabia, should focus on disseminating accurate sunscreen use guidelines to maximize sun protection and skin health.

A UV-related risk analysis in ophthalmic malignancies: Increased UV exposure may cause ocular malignancies

Purpose

To explore the role of ultraviolet radiation (UVR) in the occurrence and development of various ocular malignancies.

Methods

In this article, we retrieved ocular malignancy data from the Global Cancer Observatory (GCO) and performed correlation analysis with the global UV index and sunshine duration. We searched for associated studies using the following databases: Embase, Pubmed, Cochrane Library, and Google Scholar. We conducted the literature by searching the Mesh terms denoting an exposure of interest ("UV radiation", "ultraviolet rays", and "ocular malignancies", All studies included are published until December 30, 2023 without language restrictions.

Results

The mechanisms and epidemiological statistics of UVR on the onset and progression of eyelid malignancies are the most studied and clear. The role of UVR in conjunctival melanoma is similar to that in eyelid melanoma. The relationship between uveal melanoma and UVR is controversial, however, it may have at least a certain impact on its prognosis. UVR causes ocular surface squamous neoplasia by further activating HPV infection.

Conclusions

UVR is a decisive risk factor for ocular malignancies, but the incidence of ultraviolet-induced tumors is also affected by many other factors. A correct and comprehensive understanding of the mechanisms of UVR in the pathogenesis of ocular malignant tumors can provide patients with more effective and selective immune regulation strategies.

Incidence of Nonmelanoma Skin Cancers in Alberta, Canada, From 2007 to 2018

BACKGROUND

Nonmelanoma skin cancer (NMSC) is the most common malignancy affecting Caucasian populations and has been seeing steady increases in incidence globally for decades. Our previous study (from Alberta, Canada) had shown a plateau in the incidence rates for NMSC. This contrasts with data from other regions within Canada and throughout the world that indicated a continued increase in incidence rates of NMSCs.

OBJECTIVES

The objective of this study was to provide an update on the trends in incidence of NMSC in Alberta, Canada, from 2007 to 2018.

METHODS

A retrospective analysis of patients from Alberta diagnosed with NMSC from 2007 to 2018 inclusive was conducted with data retrieved from Alberta Cancer Registry. Sex-, age-, anatomical location-, NMSC subtype-, stage-specific incidence rates and trends were examined.

RESULTS

From 2007 to 2018, overall incidence rates of NMSC increased by 36%. Invasive squamous cell carcinoma (SCC) and in situ SCC demonstrated the most significant increase, invasive SCC [annual percentage change (APC) 3.48, P = .014] and in situ SCC (APC 5.61, P = .0001). In addition, we were able to determine that females had the most significant increases in NMSC incidence rates from 2007 to 2018 particularly invasive SCC (APC 3.03, P = <.0001) and in situ SCC (APC 5.08, P = <.0001).

CONCLUSIONS

After initial levelling of NMSC incidence in Alberta in the early part of 21st century, the incidence of NMSC continues to increase over the past decade. The reasons for this change are not clear and likely multifactorial.

A cost-minimization analysis comparing teledermoscopy and face-to-face evaluations of suspicious skin lesions in Southern Denmark

INTRODUCTION

Skin cancers are common in European populations and generate considerable costs. In Denmark, patients with suspicious skin lesions will usually consult their general practitioner who may refer the patient to a dermatologist or plastic surgeon if necessary. However, it is also possible for the general practitioner to take and send dermoscopic and macroscopic photographs of the suspicious skin lesion for evaluation by a dermatologist, so-called teledermoscopy. This study aims to calculate and compare costs of teledermoscopy and standard care in the form of face-to-face evaluation by a dermatologist of suspicious skin lesions referred by general practitioners in the Region of Southern Denmark.

METHODS

A cost-minimization study was performed. Investment costs, costs in general practice, hospital-associated costs and patient costs were included to calculate the average cost per patient episode.

RESULTS

The overall cost of teledermoscopy was €17.2-€23.1 higher than that of standard care. However, hospital-associated costs and patient costs were reduced.

DISCUSSION

The total cost of teledermoscopy was slightly higher than the cost of standard care. Sensitivity analyses indicated that the number of preventable face-to-face evaluations and the distance to the dermatologist were the two factors that influenced costs the most.

Impact of coconut kernel extract on carcinogen-induced skin cancer model: Oxidative stress, C-MYC proto-oncogene and tumor formation

This study aimed at analysing the effects of coconut (Cocos nucifera L.) kernel extract (CKE) on oxidative stress, C-MYC proto-oncogene, and tumour formation in a skin cancer model. Tumorigenesis was induced by dimethylbenz[a]anthracene (DMBA)/12-O-tetradecanoylphorbol-13-acetate (TPA). In vitro antioxidant activity of CKE was assessed using 2, 2-diphenyl-1-picrylhydrazyl (DPPH), hydrogen peroxide (H2O2), total phenolic and flavonoid content assays. CKE showed a higher antioxidant activity then ascorbic acid (*P < 0.05, ****P < 0.0001). HPLC and NMR study of the CKE revealed the presence of lauric acid (LA). Following the characterization of CKE, mice were randomly assigned to receive DMBA/TPA Induction and CKE treatment at different doses (50, 100, and 200 mg/kg) of body weight. LA 100 mg/kg of body weight used as standard. Significantly, the CKE200 and control groups' mice did not develop tumors; however, the CKE100 and CKE50 treated groups did develop tumors less frequently than the DMBA/TPA-treated mice. Histopathological analysis revealed that the epidermal layer in DMBA-induced mice was thicker and had squamous pearls along with a hyperplasia/dysplasia lesion, indicating skin squamous cell carcinoma (SCC), whereas the epidermal layers in CKE200-treated and control mice were normal. Additionally, the CKE treatment demonstrated a significant stimulatory effect on the activities of reactive oxygen species (ROS), glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD), as well as an inhibitory effect on lipid peroxidase (*P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001) and c-MYC protein expression (*P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001). In conclusion, CKE prevents the growth of tumors on mouse skin by reducing oxidative stress and suppressing c-MYC overexpression brought on by DMBA/TPA induction. This makes it an effective dietary antioxidant with anti-tumor properties.

Pinch Grafting: A Systematic Review of Modern Perspectives and Applications in Dermatologic Surgery and Wound Healing

BACKGROUND

Pinch grafting has experienced a resurgence in interest in recent years, stemming from its simplicity, safety, and potential in restoring tissue integrity. While historically employed for chronic nonhealing wounds, pinch grafts have shown promise following surgical procedures, particularly those involving the lower extremities.

OBJECTIVE

To systematically review the literature and present an updated overview of the current applications of pinch grafting.

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In collaboration with a medical reference librarian, the PubMed, Embase, Scopus, and Web of Science databases were searched for studies reporting on the use of pinch grafting from 2000 onward. The references of each included article were also screened.

RESULTS

Ten articles met final inclusion criteria. In total, 300 patients underwent pinch grafting for treatment of skin ulceration, while an additional 35 cases were performed as an alternative to primary closure following skin cancer resection. Overall, pinch grafting was safe and well tolerated, with minimal adverse outcomes reported.

CONCLUSION

Pinch grafting is a safe, straightforward, and effective technique to promote the healing of chronic wounds. While the procedure shows early promise in emerging applications within dermatologic surgery, only about 10% of the reported cases involved this indication, reflecting a need for further research in this area.

The effect of hair removal and filtering on melanoma detection: a comparative deep learning study with AlexNet CNN

Melanoma is the most aggressive and prevalent form of skin cancer globally, with a higher incidence in men and individuals with fair skin. Early detection of melanoma is essential for the successful treatment and prevention of metastasis. In this context, deep learning methods, distinguished by their ability to perform automated and detailed analysis, extracting melanoma-specific features, have emerged. These approaches excel in performing large-scale analysis, optimizing time, and providing accurate diagnoses, contributing to timely treatments compared to conventional diagnostic methods. The present study offers a methodology to assess the effectiveness of an AlexNet-based convolutional neural network (CNN) in identifying early-stage melanomas. The model is trained on a balanced dataset of 10,605 dermoscopic images, and on modified datasets where hair, a potential obstructive factor, was detected and removed allowing for an assessment of how hair removal affects the model's overall performance. To perform hair removal, we propose a morphological algorithm combined with different filtering techniques for comparison: Fourier, Wavelet, average blur, and low-pass filters. The model is evaluated through 10-fold cross-validation and the metrics of accuracy, recall, precision, and the F1 score. The results demonstrate that the proposed model performs the best for the dataset where we implemented both a Wavelet filter and hair removal algorithm. It has an accuracy of 91.30%, a recall of 87%, a precision of 95.19%, and an F1 score of 90.91%.