Skin cancer screening in Okinawa, Japan

Trapdoor Deformity Correction Post Nasal Bilobed Flaps for Basal Cell Carcinoma Reconstruction With Multiple Laser Modalities

ABSTRACT

In case of excision of nasal basal cell carcinoma (BCC), bilobed flaps are considered the criterion standard of reconstruction for defect less than 15 mm in size. However, there is still a risk of trapdoor deformity formation, of which its treatment is less discussed. A 44-year-old woman who was diagnosed with nasal BCC and underwent tumor excision with bilobed flap reconstruction presented with trapdoor deformity postoperatively. The computed Vancouver Scar Scale was 7. After early intervention of multiple laser modalities, including 2 sessions of 585-nm pulsed dye laser with a fluence of 9 J/cm2, pulse duration of 6 milliseconds, and spot size of 6 mm, 2940-nm Er-yttrium aluminum garnet (YAG) laser with a pulse energy of 800-900 mJ, repetition rate of 8-9 Hz, and laser spot size of 3-7 mm, and 5 sessions of 1064-nm Nd:YAG fractional picosecond laser with a pulse energy of 2.30-2.70 mJ, repetition rate of 8 Hz, and laser spot size of 6 mm from 5 to 23 weeks postoperatively, the Vancouver Scar Scale score improved to 1, with significant reduction of trapdoor scar erythema and puffiness. Although BCC is often curable, tumor excision causes unsatisfactory appearance satisfaction problem, owing to the apparent location of the lesion. Factors, such as sebaceous tissue thickness, reconstruction over multiple aesthetic subunits of nose, and damage to nasal cartilage framework structure during tumor removal, may increase the risk of trapdoor formation. Early intervention with multiple laser treatment can significantly revise the deformity.

Characteristics of women who dropped out from pregnancy register in Okinawa, Japan: Findings from a retrospective cohort study

AIM

There is little evidence regarding women who cannot register live births after pregnancy. We aimed to clarify the difference in baseline characteristics between women who registered live births and those who did not (i.e., dropout).

METHODS

We assessed the birth cohort data of 1976 Japanese women who registered their pregnancies between July 2013 and March 2014 in Naha and Urasoe City, Okinawa, Japan. The database consisted of anthropometric data, reproductive history, sociodemographic characteristics, and dietary intake. We estimated the prevalence ratio to examine the associations of baseline characteristics with dropout by multivariable-adjusted Poisson regression with robust standard error estimation.

RESULTS

We identified 272 dropouts (13.8%) in the pregnancy registry. About 15% of women reported experience of alcohol drinking preceding 1 month of pregnancy registration. Most participants' vitamin B1 (92.1%) and folate (74.7%) consumption was inadequate considering the dietary reference intake for Japanese pregnant women, but it was not associated with a high prevalence of dropout. The prevalence of dropout was significantly higher in teenagers (prevalence ratio [PR] = 2.06, 95% confidence interval [CI] 1.38-3.07) and early 20s (PR = 1.42, 95% CI 1.04-1.93) than in women in late 20s. In addition, alcohol consumption was potentially associated with a high prevalence of dropout (adjusted prevalence ratio [aPR] = 1.31, 95% CI 0.99-1.73). Participants who experienced one or more live births (aPR = 0.43, 95% CI 0.28-0.66) were less likely to dropout.

CONCLUSION

We found that the potential risk factors for dropout from pregnancy registration were young maternal age, no childbirth experience, and alcohol consumption.

Japanese Dermatological Association Guidelines: Outlines of Guidelines for Cutaneous Squamous Cell Carcinoma 2020

In consideration of the development of treatment options for squamous cell carcinoma (SCC), the Japanese Skin Cancer Society issued the first guidelines of SCC in 2007 and revised them in 2015. Here, we report the English version of the 2020 edition of the Japanese SCC guidelines. The first half of this article is an overview of SCC including actinic keratosis and Bowen's disease, and the second half discusses three clinical questions: (i) treatment of actinic keratosis; (ii) determination of the resection margin of the primary lesion; and (iii) treatment of radically incurable cases, as contemporary problems encountered in treating SCC. In these evaluations, all processes were implemented according to the Grading of Recommendations, Assessment, Development, Evaluation system. Also, items of recommendation concerning each clinical question were determined by a multidisciplinary expert panel consisting of dermatologists, plastic/reconstructive surgeons, radiologists, and oncologists through a comprehensive literature search and systematic reviews.

Skin Cancer Screening on a Fishing Island and in an Inland Agricultural Area of Japan

We performed skin cancer screening from 2000 to 2004 at two locations in Japan's Oita Prefecture: Himeshima, a small fishing island, and Naoiri, an inland agricultural area. We found 108 and 21 cases of AK in Himeshima and Naoiri, respectively. None of the AKs transformed into SCC, and 21.7% of the AKs underwent spontaneous remission during our observation period. The prevalence and incidence of AK in Himeshima were five times higher than in Naoiri: 1,399 and 826 per 100,000 population, respectively, in the fishing village, vs. 261 and 164 in the agricultural community. Seven and three cases of BCC were observed in Himeshima and Naoiri, respectively. There were two cases of SCC in Himeshima. The highest risk ratio of skin types I to III was 9.2 in Himeshima. Although people engaged in outdoor occupations are thought to be more prone to skin cancer and precancerous skin lesions, our results suggested different potentials for AK in people engaged in different outdoor occupations.

Screening for skin cancer: a pilot study in tehran, iran

BACKGROUND

Early detection of skin cancers by screening could be very beneficial to decrease their morbidity or mortality. There is limited study about skin cancer screening in Iran.

AIM

This essay was planned as a pilot skin cancer screening campaign in Tehran, Iran to evaluate its profit and failure and further design large-scale screening program more definitely.

MATERIALS AND METHODS

Thirty one public health centers of Shahid Beheshti Medical University were selected in different areas of Tehran. The project was announced via media and invited all the people above 40 years old to come for the whole-body skin examination in a one-week period. Patients with any suspected lesions were referred to the dermatology clinics of the university.

RESULTS

1314 patients, 194 males (14.8%) and 120 females (85.2%), with mean age of 51.81 ± 10.28 years participated in this screening campaign. Physicians found suspected lesions in 182 (13.85%) of participants. The diagnosis of skin cancer was confirmed in 15 (1.14%) patients. These malignancies included 10 (0.76%) cases of basal cell carcinoma, 2 (0.15%) cases of squamous cell carcinoma and 3 (0.23%) cases of malignant melanoma.

CONCLUSION

Skin cancer screening seems to be valuable to detect skin malignancies in their early course. Regarding the considerable amount of facilities needed to perform skin cancer screening program, it might be more beneficial to perform the targeted screening programs for the high-risk groups or emphasis more on public education of skin cancer risk factors and their early signs.

OCA2*481Thr, a hypofunctional allele in pigmentation, is characteristic of northeastern Asian populations

Asians as well as Europeans have light skin, for which no genes to date are known to be responsible. A mutation, Ala481Thr (c.G1559A), in the oculocutaneous albinism type II (OCA2) gene has approximately 70% function of the wild type allele in melanogenesis. In this study, the distribution of the mutation was investigated in a total of 2,615 individuals in 20 populations from various areas. OCA2 481Thr prevailed almost exclusively in a northeastern part of Asia. The allele frequency was highest in Buryat (0.24) in Mongolia and showed a north-south downward geographical gradient. These findings suggest that OCA2 481Thr arose in a region of low ultraviolet radiation and thereafter spread to neighboring populations.

Skin cancer in skin of color

Skin cancer is less common in persons with skin of color than in light-skinned Caucasians but is often associated with greater morbidity and mortality. Thus, it is crucial that physicians become familiar with skin cancer in persons of color so as to maximize the likelihood of early detection of these tumors. In dark-skinned ethnic groups, squamous cell carcinoma is most common; squamous cell carcinoma and melanoma usually occur on nonsun-exposed sites; and ultraviolet radiation is not an important etiologic factor for skin cancer with the exception of basal cell carcinoma. Races of intermediate pigmentation, such as Hispanics and Asians, share epidemiologic and clinical features of dark-skinned ethnic groups and Caucasians. Skin cancers pose a significant risk in skin of color and clinicians should focus on preventive measures in these groups such as regular skin exams, self-examination, public education, and screening programs.

LEARNING OBJECTIVE

At the completion of this learning activity, participants should be familiar with the epidemiology and unique clinical features of skin cancer in skin of color and be aware of strategies to prevent skin cancer in skin of color.

Plant self-defense mechanisms against oxidative injury and protection of the forest by planting trees of triploids and tetraploids

The depletion of the ozone layer, and the resulting substantial increase in incident ultraviolet (UV) irradiation and subsequent oxygen radical formation on the Earth, have caused an extensive variety of damage to the world's forests. Superoxide dismutase (SOD), catalase, and glutathione peroxidase (GSH-Px), which scavenge harmful oxygen radicals and inhibit lipid peroxides, were examined in two types of Japanese cedars, black pines, and cypresses, namely those with leaves showing premature withering, shedding, or dying and those with leaves not showing these effects prematurely. The effect of homogenates from these trees on lipid peroxide formation in a reaction system which UV light induces was also studied. The results indicate that strong black pines have significantly higher SOD activities than ordinary black pines, the leaves of which prematurely wither or die. Remarkably, trees that had triploid or tetraploid chromosomes showed higher SOD levels than diploid trees and markedly inhibited lipid peroxide formation since the SOD gene resides on a chromosome. This was especially true of plus trees of Japanese cypress, some of which had five times higher SOD activities than common Japanese cypresses although GSH-Px appears to play less of a role in this regard. Rice leaves and osmunda which are resistant to UV damage showed markedly higher SOD and GSH-Px activity. Our experiments suggest that the trees that have high SOD can protect themselves by scavenging oxygen radicals induced by UV irradiation and inhibit harmful lipid peroxide formation. In order to protect forests from oxidative damage by UV light, we should plant trees of natural mutants and artificially crossed triploids and tetraploids.