Nonmelanoma skin cancer in women

The risk information and skin-cancer education for undergraduate prevention (RISE-UP) study: Protocol for a trial of personalized sun protection interventions for skin cancer prevention among undergraduate students

BACKGROUND

Addressing the increasing incidence of skin cancer among young adults is a priority. The objective of the Risk Information and Skin-cancer Education for Undergraduate Prevention (RISE-UP) study is to identify personalized intervention components to prevent sunburn, a clinically significant outcome highly associated with skin cancer, in college students.

METHODS

Guided by the Elaboration Likelihood Model, the study will use Multiphase Optimization Strategy (MOST) methodology to test three intervention components (ultraviolet photography, MC1R genetic testing, and action planning) each with two levels (yes v. no) in a full-factorial experiment to evaluate unique and combined effects of these components to improve outcomes over the longer-term, with seasonally timed follow-up. At-risk University of Utah students (N = 528) will be recruited. Eligibility criteria include self-reported sunburn or tanning in the past year, or not utilizing recommended sun protection. After baseline assessment, participants will be randomized to intervention group, stratified by sex. Assessments will be completed at (1) Baseline; (2) Intervention; (3) 1 month after intervention; (4) 4 months after intervention (the end of the first summer); and (5) 15 months after intervention (the end of the second summer). The primary outcome will be participants' self-reported number of sunburns. Secondary outcomes will include self-reported sun protection and tanning behaviors and, in a randomly selected subgroup, an objective measure of ultraviolet radiation (UVR) exposure.

CONCLUSION

The RISE-UP study will determine the efficacy of different combinations of personalized skin cancer preventative interventions for young adults and determine the optimal combination of intervention components to prevent skin cancer.

CLINICAL TRIAL REGISTRATION

NCT05634252.

'I had a bigger cancer risk than I thought…': The experience of receiving personalized risk information as part of a skin cancer prevention intervention in the college setting

BACKGROUND

Diagnoses of both melanoma and nonmelanoma skin cancers are becoming increasingly common among young adults. Interventions in this population are a priority because they do not consistently follow skin cancer prevention recommendations.

OBJECTIVES

The goal of the current study was to examine college students' perspectives on and experience with receiving a skin cancer prevention intervention that provided personalized skin cancer risk feedback in the form of an ultraviolet (UV) photograph, the results of genetic testing for common skin cancer risk variants, and/or general skin cancer prevention education.

METHODS

Qualitative interviews were conducted with 38 college students who received a skin cancer prevention intervention. The interview covered students' feelings about their personal skin cancer risk information, the impact of the intervention on their skin cancer risk perceptions, actions or intentions to act with regard to their sun protection practices and feedback for improvement of the intervention content or delivery.

RESULTS

Participants reported that different intervention components contributed to increased awareness of their sun protection behaviours, shifts in cognitions about and motivation to implement sun protection strategies and reported changes to their skin cancer prevention strategies.

CONCLUSION

Our findings indicate that college students are interested in and responsive to these types of multicomponent skin cancer preventive interventions. Further, students demonstrate some motivation and intentionality toward changing their skin cancer risk behaviour in the short term.

PATIENT OR PUBLIC CONTRIBUTION

Participants involved in this study were members of the public (undergraduate students) who were involved in a skin cancer prevention intervention, then participated in semistructured interviews, which provided the data analysed for this study.

Trends in Cancers of the Skin: Insights from a Three-year Observational Cohort in Manhattan Beach, California

Background

There exists significant heterogeneity in the presentation of "common" skin cancers such as cutaneous melanoma (CM), cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). Meaningful differences are often observed among the trio concerning age, sex, site at presentation and laterality.

Objective

In this paper, we endeavor to elucidate such heterogeneity, reaffirm burgeoning trends in skin cancer incidence, and offer new insights in the presentation of common skin cancers.

Results

While agreement with current consensus was achieved with regard to various aspects of sex, age, and site-specific findings, several novel results emerged: (1) the percentage of subjects presenting with CM was demonstrably higher than population averages would estimate; (2) melanoma exhibited a pronounced right-side bias; (3) cSCC was not head and neck preferring as other reviews have documented (4) cSCC exhibited greater female bias.

Conclusion

In this study, we documented insights from 663 cases (397 unique subjects) across a range of factors including age, laterality, site of presentation, and sex specific differences in incidence. The results of our analysis generally accord well with previous findings, replicating several of the most prominent results.

Association of Age, Sex, Race, and Geographic Region With Variation of the Ratio of Basal Cell to Cutaneous Squamous Cell Carcinomas in the United States

Importance

Defining which populations are affected by basal cell carcinoma (BCC) vs cutaneous squamous cell carcinoma (cSCC) may inform targeted public health strategies. Incidence of BCC and cSCC is not reported to national cancer registries, but claims data for the treatment of BCC and cSCC provide insights into the epidemiology of keratinocyte carcinoma.

Objective

To define differences in the ratio of BCC to cSCC in adults (age, ≥18 years) in a large database of patients with commercial insurance and Medicare Advantage coverage.

Design, Setting, and Participants

This cross-sectional analysis used deidentified data derived from the Optum Clinformatics Data Mart to perform a retrospective evaluation of a large commercially insured cohort based on treatment claims from January 1, 2012, to December 31, 2016. Patients with a diagnosed and treated BCC or cSCC as determined by codes from the International Classification of Diseases, Ninth Revision, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and Current Procedural Terminology were included. Data were analyzed from November 30, 2019, to March 20, 2020.

Exposure

Diagnosis and treatment of BCC or cSCC.

Main Outcomes and Measures

The ratio of BCC to cSCC based on age, sex, race, and geographic location. Multivariable logistic regression was used to assess how demographics were associated with the odds of a treated keratinocyte carcinoma being a BCC.

Results

Among the 985 317 claims for patients included in the analysis (61.59% for men; mean [SD] age, 69.82 [12.58] years), BCCs were 1.69 (95% CI, 1.6899-1.6901) times more likely than cSCCs to be treated in the United States from 2012 to 2016. Basal cell carcinomas were significantly more prevalent than cSCCs in younger patients (18-39 years, 9.63 [95% CI, 9.6088-9.6574] BCCs per cSCC; 40-64 years, 2.92 [95% CI, 2.9171-2.9187] BCCs per cSCC; and ≥65 years, 1.33 [95% CI, 1.3289-1.3291] BCCs per cSCC; P < .001). Basal cell carcinomas were significantly more prevalent than cSCCs in women vs men, except in adults 65 years or older (odds ratios [ORs], 0.98 [95% CI, 0.97-0.99] vs 1.67 [95% CI, 1.47-1.88] for those aged 18-39 and 1.15 [95% CI, 1.12-1.19] for those aged 40-64 years; P < .001). The difference in BCC:cSCC ratios between men and women diminished with increasing age (OR, 1.67 for 18-39 years, 1.15 for 40-64 years, and 0.98 for 65 years or older). Basal cell carcinoma was more prevalent than cSCC in all races, including Black patients (BCC:SCC ratios, 1.60 for Asian patients, 1.45 for Black patients, 2.00 for Hispanic patients, and 1.69 for White patients of all ages). The BCC:cSCC ratio varied based on geography, with the highest ratio in the West North Central census division (2.12) and the lowest ratio in the South Atlantic census division (1.35).

Conclusions and Relevance

In the absence of a national registry, claims data can improve our understanding of the epidemiology of keratinocyte carcinomas. In this cross-sectional study, basal cell carcinomas were more common than cSCCs for all demographics, including in Black patients. In populations younger than 40 years, BCCs were 12.6 times more likely for women and 7.2 times more likely for men. These demographic groups may benefit from public health education focused on the presentation and management of BCCs.

Sex Differences in Health-related Quality of Life in Patients with Keratinocyte Carcinomas

The difference between men and women in the impact of keratinocyte carcinomas on quality of life has not been widely studied. This study of 364 patients with keratinocyte carcinoma, measured quality of life using the self-administered 12-item Short Form Health Survey (SF-12) and Skindex-29. Results for both the physical and the mental components of SF-12 were worse in women than in men. For the mental component, women had significantly lower scores compared with men in almost all subgroups, based on demographic and clinical variables. The Skindex-29 emotions mean score was worse in women than in men. Women reported significantly higher level of worry that the disease could get worse and of developing scars, and more depression. On the other hand, men reported lower quality of sleep. The impact of keratinocyte carcinomas on quality of life is generally higher in women than in men. Such data may be important for tailored management of the disease in different categories of patients.

Exogenous sex hormones, menstrual and reproductive history, and risk of non-melanoma skin cancer among women: a systematic literature review and meta-analysis

Non-melanoma skin cancers (NMSC) are more frequent among men, but women (especially those aged < 40 years) have experienced steeper growth in their incidence rates in recent years. Hormonal factors were hypothesized to be playing a role in modulating NMSC risk, but the studies published to date provided conflicting results. We systematically reviewed and meta-analysed the studies focusing on the association between hormone-related characteristics (use of exogenous sex hormones, and aspects of menstrual and reproductive history) and the risk of NMSC among women. We included observational and experimental studies published in PubMed and EMBASE until February 2020. We calculated summary relative risk (SRR) and 95% confidence intervals (CI) by applying random effects models with maximum likelihood estimation, and used the I2 statistics to quantify the degree of heterogeneity of risk estimates across studies. Eleven independent studies encompassing a total of over 30,000 NMSC cases were included in quantitative analyses. No evidence of an increased NMSC risk emerged among ever vs. never users of oral contraceptives (SRR 1.13, 95% CI 0.88-1.45) or hormones for menopause (SRR 1.09, 95% CI 0.87-1.37). Likewise, age at menarche or at menopause and parity were not associated with NMSC risk. Heterogeneity across studies was low, and pooled results were comparable between NMSC subtypes. We found no evidence that hormonal factors play a role in the pathogenesis of NMSC among women.

Retrospective evaluation of the performance of the electrical impedance spectroscopy system Nevisense in detecting keratinocyte cancers

BACKGROUND

Keratinocyte cancers, also referred to as non-melanoma skin cancers (NMSCs), are one of the most common malignant skin tumors. We performed a retrospective analysis of lesions from patients of a private dermatology practice to evaluate the use of electrical impedance spectroscopy (EIS) in detecting keratinocyte malignancies. The aim of the study is to assess the accuracy of the technique and to rate its use as supportive tool in NMSC diagnosis.

MATERIAL AND METHODS

The period evaluated ranges from September 2015 to November 2019. In total, 1712 lesions from 951 patients were included. All lesions suspicious for malignancy were gauged with the Nevisense device. Excised lesions were sent in for histopathological classification, and the results were compared to the Nevisense score.

RESULTS

A total of 767 lesions (44.8%) received a negative score (0-3) from the Nevisense system and 945 lesions (55.2%) a positive score (4-10). The combination of the dermatologist's visual assessment plus the technical determined Neviscore resulted in the excision of 52.5% of all 1712 suspicious lesions whereof 15% were found to be malignant. The sensitivity of Nevisense was 98.4% for NMSC detection.

CONCLUSION

Electrical impedance spectroscopy was found to be a valuable adjunct support tool in clinical decisions for cases with suspicion for NMSC.