Bedeutung von ultravioletter Strahlung beim malignen Melanom

Psychosocial Care Needs of Melanoma Survivors: Are They Being Met?

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as 'in need', the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life.

[Principles of skin pigmentation. Biochemistry and regulation of melanogenesis]

Skin pigmentation is highly determined by genetic factors and so far more than 150 genes have been identified that affect skin color either directly or indirectly. The production of eu- and pheomelanin in melanosomes results from the complex interaction between melanogenic regulators in melanocytes and factors derived from keratinocytes and fibroblasts. Besides genetic determination, pigmentation depends on environmental and endocrine factors that modulate the amount, type and distribution of melanins in the skin. Understanding the intrinsic mechanisms of melanogenesis is the basis for modifications of skin pigmentation which are of great interest pharmaceutically and cosmeceutically.

UV-induced skin cancer at workplace and evidence-based prevention

PURPOSE

The present review is aimed at providing an overview of skin cancer with particular focus on occupational concern and giving evidence-based recommendation for effective prevention at workplace.

METHODS

We performed a systematic search of literature using PubMed and the Cochrane Library.

RESULTS

Outcome of preventive strategies depends either on efficacy of the strategy itself but also on acceptance and implementation of protective means among the persons at possible risk for hazardous health effects. Epidemiological studies have reported significantly more non-melanoma skin cancer in men than in women. Life-style choices and difference in immunosuppression play a major role in this gender disparity. Tumor biology of skin cancer is diverging: severe blistering sunburns corresponding to intermittent intense UV exposures are associated with an increased risk for both melanoma and basal cell carcinoma (BCC); whereas the risk of squamous cell carcinoma (SCC) and actinic keratoses (AK) is strongly associated with chronic UV exposure. Several clinical trials give evidence that long-term use of sunscreen prevents the appearance of non-melanotic skin cancer such as AK and SCC, but not of BCC. All technical and organizing measures aimed at reducing UV exposure at workplace belong to first-line prevention; however, there is much room for improvement. The efficacy of personal protection means (second-line strategy) strongly depends on the workers' compliance which is quite low at workplace.

CONCLUSION

Evidence-based data confirming the benefit of sun protective strategies are scarce, general recommendations are mainly based on the avoidance of UV radiation being identified as potential risk factor for non-melanoma skin cancer in epidemiological studies. Occupational screenings should include regular interventions aimed at enhancing a clear understanding of risk factors for individuals and finally improving the acceptance and maintenance for UV-protective means at workplace.

[Photocarcinogenesis. Molecular mechanisms and preventive strategies]

Ultraviolet (UV) radiation is the main carcinogen in the development of epithelial skin cancer. A variety of biological and molecular effects in the skin have been described. In order to avoid malignant transformation, various protective mechanisms have developed in the skin, whereby p53 plays a central role. UV signature mutations in p53, Ras and INK4a/ARF as well as UV-induced NFkappaB and cyclooxygenase 2 are principally involved in photocarcinogenesis. Chemoprevention has gained increasing importance for primary prevention. Numerous natural or synthetic substances can be antiinflammatory, antioxidative, proapoptotic or antiproliferative and suppress photocarcinogenesis. Extensive clinical data exist for the use of retinoids systemically or DNA repair enzymes topically. However, clinical trials are lacking, for example for green tea, which has been shown repeatedly to be chemoprotective in vitro and in mouse models after topical or oral application.

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

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