Non-Melanoma Skin Cancer Incidence and Impact of Skin Cancer Screening on Incidence

Warmer Temperatures Are More Predictive Than Solar Radiation for the Number of Skin Cancer Removal Procedures

BACKGROUND

Solar radiation is the primary risk factor for skin cancer, with personal exposure influenced by environmental and behavioral factors. At higher temperatures, behavioral changes increase solar radiation exposure.

OBJECTIVES

Examine the relationships between solar radiation, ambient temperature, age, and skin cancer.

METHODS

For the contiguous United States, we obtained the state mean global horizontal irradiance (GHI), daily maximum temperature, and number of skin cancer removals in the Medicare population. For skin cancer removals, we defined more sun-exposed skin as the head, neck, hands, and feet, and less sun-exposed skin as the trunk, arms, and legs.

RESULTS

By comparing the temperature thresholds 17°C, 20°C, 24°C, 27°C, 31°C, and 34°C, we found that the annual number of days above 24°C was the strongest temperature-related predictor of skin cancer removals. Multivariable linear regression showed that the number of days above 24°C predicted more skin cancer removals for all body locations and less sun-exposed skin (p = 0.008 and p = 0.003, respectively), while GHI did not (p = 0.1 and p = 0.8, respectively). GHI only predicted more skin cancer removals for more sun-exposed skin (p = 0.02).

CONCLUSION

More days above 24°C was a better predictor of skin cancer removals than GHI for all skin locations and less sun-exposed skin, suggesting that the behavioral changes occurring at warmer temperatures are more predictive of skin cancer removals than solar irradiance. Due to rising global temperatures, skin cancer incidence may further increase. Temperature-related behavioral changes represent a potential target for skin cancer prevention efforts.

Using computational learning for non-melanoma skin cancer and actinic keratosis near-infrared hyperspectral signature classification

BACKGROUND

The early detection of Non-Melanoma Skin Cancer (NMSC) is essential to ensure patients receive the most effective treatment. Diagnostic screening tools for NMSC are crucial due to high confusion rates with other types of skin lesions, such as Actinic Keratosis. Nevertheless, current means of diagnosing and screening patients rely on either visual criteria, that are often conditioned by subjectivity and experience, or highly invasive, slow, and costly methods, such as histological diagnoses. From this, the objectives of the present study are to test if classification accuracies improve in the Near-Infrared region of the electromagnetic spectrum, as opposed to previous research in shorter wavelengths.

METHODS

This study utilizes near-infrared hyperspectral imaging, within the range of 900.6 and 1454.8 nm. Images were captured for a total of 125 patients, including 66 patients with Basal Cell Carcinoma, 42 with cutaneous Squamous Cell Carcinoma, and 17 with Actinic Keratosis, to differentiate between healthy and unhealthy skin lesions. A combination of hybrid convolutional neural networks (for feature extraction) and support vector machine algorithms (as a final activation layer) was employed for analysis. In addition, we test whether transfer learning is feasible from networks trained on shorter wavelengths of the electromagnetic spectrum.

RESULTS

The implemented method achieved a general accuracy of over 80 %, with some tasks reaching over 90 %. F1 scores were also found to generally be over the optimal threshold of 0.8. The best results were obtained when detecting Actinic Keratosis, however differentiation between the two types of malignant lesions was often noted to be more difficult. These results demonstrate the potential of near-infrared hyperspectral imaging combined with advanced machine learning techniques in distinguishing NMSC from other skin lesions. Transfer learning was unsuccessful in improving the training of these algorithms.

CONCLUSIONS

We have shown that the Near-Infrared region of the electromagnetic spectrum is highly useful for the identification and study of non-melanoma type skin lesions. While the results are promising, further research is required to develop more robust algorithms that can minimize the impact of noise in these datasets before clinical application is feasible.

Ex Vivo Confocal Microscopy Speeds up Surgical Margin Control of Re-Excised Skin Tumors and Greatly Shortens In-Hospital Stay

BACKGROUND/OBJECTIVES

To ensure that non-melanoma skin cancer (NMSC) is completely removed in healthy tissue, micrographically controlled surgery (3D histology) is often performed, which can prolong the inpatient stay. This study examined ex vivo reflectance confocal microscopy (evRCM) for perioperative assessment of surgical margins, specifically in cases where re-excision was necessary due to incomplete removal of cutaneous tumor tissue.

METHODS

NMSC re-excisions were evaluated using evRCM by a cutaneous surgeon, with retrospective review by an independent pathologist when results differed from histology.

RESULTS

evRCM demonstrated high specificity (0.96; 95% CI, 0.90-0.99) but low sensitivity (0.20; 95% CI, 0.06-0.51). Unlike pathology, which discards outer surgical margins, evRCM examined the true surgical margins. Retrospective pathology analysis of the misdiagnosed cases confirmed that 25% (n = 2/8) were false negative and 75% (n = 6/8) were potentially false positive, resulting in a sensitivity of 0.2-0.8. Notably, evRCM led to a 113-day reduction in in-hospital stays, probably resulting in increased patient satisfaction and cost-effectiveness.

CONCLUSIONS

evRCM was valuable for speeding up the assessment of surgical margins in patients with re-excised NMSC. Proper tissue preparation and assessment require interdisciplinary collaboration between cutaneous surgeons, pathologists, and physician assistants, emphasizing the need for standardized operating procedures.

The Role of Long Non-Coding RNF144A-AS1 in Cancer Progression

RNAs transcribing more than 200 nucleotides without encoding proteins are termed long non-coding RNAs (LncRNAs). LncRNAs can be used as decoy molecules, signal molecules, scaffolds, and guide molecules. Long non-coding RNAs can interact with DNA, chromatin-modifying complexes, and transcriptional regulatory proteins, regulating gene expression in the cell nucleus. It is distributed in cytoplasm; they also participate in mRNA degradation and translational regulation via miRNAs, other transcription products, and proteins. They play a significant role in the development of various diseases, including tumors. Cancer seriously threatens human life and health. Regretfully, a great deal of newly diagnosed cancer patients found to have metastasized. RNF144A-AS1, also referred to as GRASLND, was initially recognized for its regulation of chondrogenic differentiation in MSCs. Focusing on RNF144A-AS1, this review summarizes and discusses the latest progress of RNF144A-AS1 in bladder cancer, glioblastoma, papillary renal cell carcinoma, gastric cancer, osteosarcoma, head and neck squamous cell carcinoma, and ovarian cancer. RNF144A-AS1 has good potential in tumor treatment and diagnosis.

Echinatin suppresses cutaneous squamous cell carcinoma by targeting GSTM3-mediated ferroptosis

BACKGROUND

Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin cancers for which effective drugs are urgently needed. Echinatin, a natural compound extracted from Glycyrrhiza plants, has shown promising antitumour effects. However, the efficacy and the direct target of echinatin in cSCC remain unclear.

PURPOSE

This study conducted a systematic investigation of the antitumour effects of echinatin on cSCC and the underlying mechanisms involved.

STUDY DESIGN AND METHODS

Three cSCC cell lines, a xenograft model, and a UV-induced cSCC mouse model were used to investigate the potential protective effects of echinatin. The interactions between echinatin and glutathione S-transferase mu3 (GSTM3) and between echinatin and peroxiredoxin-2 (PRDX2) were evaluated by a proteome microarray assay, pull-down LC‒MS/MS analysis, surface plasmon resonance, and molecular docking. The potential mechanisms of GSTM3-mediated echinatin activity were analysed by using western blotting, lentivirus infection and small interfering RNA (siRNA) transfection.

RESULTS

In this study, we found that echinatin inhibited the proliferation and migration of cSCC cells but had no cytotoxic effect on primary human keratinocytes. Furthermore, echinatin significantly inhibited tumour growth in vivo. Mechanistically, our data showed that echinatin could directly bind to GSTM3 and PRDX2. Notably, echinatin inhibited GSTM3 and PRDX2 levels by promoting their proteasomal degradation, which led to the disruption of ROS production. We then revealed that echinatin increased mitochondrial ROS production by inhibiting GSTM3. Moreover, echinatin triggered ferroptosis by inhibiting GSTM3-mediated ferroptosis negative regulation (FNR) proteins. In addition, echinatin regulated GSTM3-mediated ROS/MAPK signalling.

CONCLUSION

Echinatin has good antitumour effects both in vitro and in vivo. Moreover, our findings indicate that GSTM3 and PRDX2 could function as viable targets of echinatin in cSCC. Consequently, echinatin represents a novel treatment for cSCC through the targeting of GSTM3-mediated ferroptosis.

Incidence, mortality and survival of Merkel cell carcinoma: a systematic review of population-based studies

BACKGROUND

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer that most commonly occurs in ultraviolet-exposed body sites. The epidemiology of MCC in different geographies and populations is not well characterized.

OBJECTIVES

The objective of this systematic review is to summarize evidence on the incidence, mortality and survival rates of MCC from population-based studies.

METHODS

We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from database inception to 6 June 2023. No geographic, age or date exclusions were applied. We included population-based studies of MCC that reported the incidence, survival or mortality rate, and also considered systematic reviews. A data-charting form was created and validated to identify variables to extract. Two reviewers then independently charted the data for each included study with patient characteristics, and estimates of incidence rate, mortality rate, and survival rate and assessed the quality of included studies using the Joanna Briggs Institute Checklist for Prevalence studies, Newcastle-Ottawa Scale and Assessment of Multiple Systematic Reviews. We abstracted age-, sex-, stage- and race-stratified outcomes, and synthesized comparisons between strata narratively and using vote counting. We assessed the certainty of evidence for those comparisons using the Grading of Recommendations, Assessments, Developments and Evaluations framework.

RESULTS

We identified 11 472 citations, of which 52 studies from 24 countries met our inclusion criteria. Stage I and the head and neck were the most frequently reported stage and location at diagnosis. The incidence of MCC is increasing over time (high certainty), with the highest reported incidences reported in southern hemisphere countries [Australia (2.5 per 100 000); New Zealand (0.96 per 100 000) (high certainty)]. Male patients generally had higher incidence rates compared with female patients (high certainty), although there were some variations over time periods. Survival rates varied, with lower survival and/or higher mortality associated with male sex (moderate certainty), higher stage at diagnosis (moderate-to-high certainty), older age (moderate certainty), and immunosuppression (low-to-moderate certainty).

CONCLUSIONS

MCC is increasing in incidence and may increase further given the ageing population of many countries. The prognosis of MCC is poor, particularly for male patients, those who are immunosuppressed, and patients diagnosed at higher stages or at an older age.

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.

Incidence and survival rates of primary cutaneous malignancies in Korea, 1999-2019: A nationwide population-based study

Primary cutaneous malignancies are among the most commonly diagnosed types of cancer worldwide. We aimed to examine the incidence and 5-year survival rates of all types of primary cutaneous malignancies in the Korean population. Data from the Korean Nationwide Cancer Registry from 1999 to 2019 were analyzed. The crude incidence rates, age-standardized incidence rates, and 5-year relative survival rates of each type of skin cancer were calculated. A total of 89 965 patients were diagnosed with primary cutaneous malignancies, which was a 7-fold increase from 1999 to 2019. The age-standardized incidence rates increased 3.4-fold in basal cell carcinoma (3.7/100 000 person-years), 2.0-fold in squamous cell carcinoma (1.6/100 000 person-years), 12.0-fold in Bowen disease (1.2/100 000 person-years), and 1.8-fold in malignant melanoma (0.7/10 000 person-years) in 2019. Average annual percentage changes in age-standardized incidence rates were statistically significant in basal cell carcinoma (15.8%), Bowen disease (5.8%), squamous cell carcinoma (5.1%), malignant melanoma (1.2%), melanoma in situ (1.1%), dermatofibrosarcoma protuberans (1.2%), mycosis fungoides (0.5%), primary cutaneous CD30+ T-cell proliferations (0.5%), adnexal and skin appendage carcinoma (0.4%), extramammary Paget's disease (0.2%), and Merkel cell carcinoma (0.2%). The 5-year relative survival rates were the highest in basal cell carcinoma (103.3%), followed by dermatofibrosarcoma protuberans (99.7%) and mycosis fungoides (96.6%), and lowest in angiosarcoma (24.7%). The 5-year relative survival rates steadily increased in extramammary Paget's disease (23.6%), cutaneous B-cell lymphoma (21.3%), mycosis fungoides (20.2%), extranodal NK/T-cell lymphoma, nasal type (18.1%), and malignant melanoma (16.1%) from 1996-2000 to 2015-2019. Most primary cutaneous malignancies have increased in incidence and survival rates in the Korean population, but to varying extents depending on the type of skin cancer.

Basic principles of artificial intelligence in dermatology explained using melanoma

The use of artificial intelligence (AI) continues to establish itself in the most diverse areas of medicine at an increasingly fast pace. Nevertheless, many healthcare professionals lack the basic technical understanding of how this technology works, which severely limits its application in clinical settings and research. Thus, we would like to discuss the functioning and classification of AI using melanoma as an example in this review to build an understanding of the technology behind AI. For this purpose, elaborate illustrations are used that quickly reveal the technology involved. Previous reviews tend to focus on the potential applications of AI, thereby missing the opportunity to develop a deeper understanding of the subject matter that is so important for clinical application. Malignant melanoma has become a significant burden for healthcare systems. If discovered early, a better prognosis can be expected, which is why skin cancer screening has become increasingly popular and is supported by health insurance. The number of experts remains finite, reducing their availability and leading to longer waiting times. Therefore, innovative ideas need to be implemented to provide the necessary care. Thus, machine learning offers the ability to recognize melanomas from images at a level comparable to experienced dermatologists under optimized conditions.

Grundprinzipien der künstlichen Intelligenz in der Dermatologie erklärt am Beispiel des Melanoms

Der Einsatz von künstlicher Intelligenz (KI) setzt sich in den verschiedensten Bereichen der Medizin immer schneller durch. Dennoch fehlt vielen medizinischen Kollegen das technische Grundverständnis für die Funktionsweise dieser Technologie, was ihre Anwendung in Klinik und Forschung stark einschränkt. Daher möchten wir in dieser Übersichtsarbeit die Funktionsweise und Klassifizierung der KI am Beispiel des Melanoms erörtern, um ein Verständnis für die Technologie hinter der KI zu schaffen. Dazu werden ausführliche Illustrationen verwendet, die die Technologie schnell erklären. Bisherige Übersichten konzentrieren sich eher auf die potenziellen Anwendungen der KI und verpassen die Gelegenheit, ein tieferes Verständnis für die Materie herauszuarbeiten, das für die klinische Anwendung so wichtig ist. Das maligne Melanom ist zu einer erheblichen Belastung für die Gesundheitssysteme geworden. Bei frühzeitiger Entdeckung ist eine bessere Prognose zu erwarten, weshalb das Hautkrebs‐Screening immer populärer und von den Krankenkassen unterstützt wird. Die Zahl der Fachärzte ist jedoch begrenzt, was ihre Verfügbarkeit einschränkt und zu längeren Wartezeiten führt. Daher müssen innovative Ideen umgesetzt werden, um die notwendige Versorgung zu gewährleisten. Das maschinelle Lernen bietet die Möglichkeit, Melanome auf Bildern zu erkennen, und zwar auf einem Niveau, das mit dem von erfahrenen Dermatologen – unter optimierten Bedingungen – vergleichbar ist.

Exploring vismodegib: A non-surgical breakthrough in the management of advanced periocular basal cell carcinoma

The management of periocular basal cell carcinoma (BCC) is challenging due to its proximity to the eyeball. Vismodegib, a Hedgehog pathway inhibitor, has emerged as a therapeutic option for locally advanced and metastatic BCC. To critically appraise the relevant evidence, we conducted a systematic review of observational and experimental studies assessing the efficacy and safety of vismodegib for periocular BCC. Thirty-seven trials, including 435 patients, were eligible. No randomized trials were retrieved. Complete and overall clinical response rates were 20-88 % and 68-100 %, respectively. Disease progression was observed at a maximum rate of 14 %. Recurrence rates varied between 0 % and 31 %. The most common side effects were muscle cramps, dysgeusia, weight loss and alopecia. Treatment with vismodegib improved health-related quality of life. In conclusion, vismodegib represents an important novel treatment for advanced periocular BCC, with good response rates and acceptable tolerability profile. Nevertheless, its full potential needs clarification through randomized controlled trials.

Epidemiology of Keratinocyte Skin Cancer with a Focus on Cutaneous Squamous Cell Carcinoma

Keratinocyte skin cancer, consisting of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is by far the most common cancer in white-skinned populations, with rapid increases over the last 50 years. While the age-standardized incidence rates increase worldwide, the age-standardized mortality rates are variable. The incidence rates of keratinocyte skin cancer are much higher compared to those of melanoma, and are largely attributed to the raising exposure to ultraviolet (UV) radiation, the most important causal risk factor for skin cancer. Whereas the development of BCC is mainly due to intense UV exposure during childhood and adolescence, the development of SCC is related to chronic, cumulative UV exposure over decades. Although mortality rates are relatively low, SCC is an increasing problem for healthcare services, significantly causing morbidity, especially in older age groups. This review reports on the epidemiology of keratinocyte skin cancer, with a focus on SCC, in Australia, the United States, and the north of Europe, with an outlook on further challenges health systems will be confronted with in the next 20 years.

Role of Insulin Use and Social Determinants of Health on Non-melanoma Skin Cancer: Results From the Behavioral Risk Factor Surveillance System

BACKGROUND

Non-melanoma skin cancer (NMSC) is a frequent type of malignancy with a steadily increasing incidence rate worldwide. Although NMSC was shown to be associated with diabetes, no studies have addressed the extent to which insulin use influences the risk of NMSC in light of social determinants of health (SDOH). We conducted a quantitative study that examined the interplay between insulin use, SDOH, additional covariates, and NMSC among individuals with diabetes.

METHODS

We based our analysis on the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a national survey conducted yearly in the US. We performed weighted chi-squared test, logistic regression, and survival analyses on 8685 eligible participants with diabetes enrolled in the BRFSS.

RESULTS

Kaplan Meier survival curves showed higher probability of NMSC event-free survival for participants with diabetes using insulin compared to participants with diabetes not using insulin (log-rank test P < .001). Significant associations were detected between insulin use and reduced odds of NMSC (OR .56; 95% CI: .38-.82), and decreased hazard (HR .36; 95% CI: .21-.62), along with indices of SDOH.

CONCLUSIONS

Our findings suggest that socioeconomic differences related to the healthcare system and behavioral patterns are linked to discrepancies in the use of insulin and the development of NMSC.

Moderne Diagnostik und Therapie des Merkelzellkarzinoms

Das Merkelzellkarzinom (MCC) ist ein seltener, aggressiver Hauttumor mit epithelialer und neuroendokriner Differenzierung, dessen Inzidenz in den letzten Jahrzehnten deutlich zugenommen hat. Risikofaktoren sind fortgeschrittenes Lebensalter, heller Hauttyp, UV‐Exposition und Immunsuppression. Pathogenetisch wird ein durch das Merkelzell‐Polyomavirus (MCPyV) hervorgerufener Typ von einem UV‐induzierten Typ mit hoher Tumormutationslast unterschieden.

Klinisch präsentiert sich das MCC als meist schmerzloser, schnell wachsender, rötlich‐violetter Tumor mit glänzender Oberfläche, der bevorzugt im Kopf‐Hals‐Bereich und an den distalen Extremitäten lokalisiert ist. Eine sichere Diagnose kann nur anhand histologischer und immunhistochemischer Merkmale gestellt werden. Bei Erstdiagnose weisen 20%–26% der Patienten lokoregionäre Metastasen und 8%–14% Fernmetastasen auf, weshalb eine Ausbreitungsdiagnostik unabdingbar ist. Bei fehlenden klinischen Hinweisen auf Metastasen wird eine Sentinel‐Lymphknotenbiopsie empfohlen.

Wesentliche Säulen der Therapie sind die Operation, die adjuvante oder palliative Strahlentherapie und in fortgeschrittenen inoperablen Stadien die medikamentöse Tumortherapie. Die Einführung von Immuncheckpoint‐Inhibitoren führte zu einem Paradigmenwechsel, da sich hiermit ein wesentlich langfristigeres Ansprechen und bessere Überlebensraten als mit Chemotherapie erreichen lassen. Zur Therapie des metastasierten MCC ist in Deutschland der PD‐L1‐Inhibitor Avelumab zugelassen, aber auch die PD‐1‐Antikörper Pembrolizumab und Nivolumab werden mit Erfolg eingesetzt. Adjuvante und neoadjuvante Therapiekonzepte, Immunkombinationstherapien und zielgerichtete Therapien als Monotherapie oder in Kombination mit Immuncheckpoint‐Inhibitoren befinden sich in klinischer Prüfung.

Modern diagnostics and treatment of Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with epithelial and neuroendocrine differentiation, the incidence of which has increased substantially during the last decades. Risk factors include advanced age, fair skin type, UV exposure, and immunosuppression. Pathogenetically, a type caused by the Merkel cell polyomavirus is distinguished from a UV-induced type with a high tumor mutational burden. Clinically, MCC presents as a mostly painless, rapidly growing, reddish-violet tumor with a shiny surface, which is preferentially localized in the head-neck region and at the distal extremities. A reliable diagnosis can only be made based on histological and immunohistochemical features. At initial diagnosis, 20-26% of patients show locoregional metastases and 8-14% distant metastases, making staging examinations indispensable. If there is no clinical evidence of metastases, a sentinel lymph node biopsy is recommended. Essential columns of therapy are surgery, adjuvant or palliative radiotherapy and, in advanced inoperable stages, medicamentous tumor therapy. The introduction of immune checkpoint inhibitors has led to a paradigm shift, as they provide a considerably longer duration of response and better survival rates than chemotherapy. The PD-L1 inhibitor avelumab is approved for treatment of metastatic MCC in Germany, but the PD-1 antibodies pembrolizumab and nivolumab are also used with success. Adjuvant and neoadjuvant treatment concepts, immune combination therapies and targeted therapies as monotherapy or in combination with immune checkpoint inhibitors are in the clinical trial phase.

Exploring multisite heterogeneity of human basal cell carcinoma proteome and transcriptome

Basal cell carcinoma (BCC) is the most common type of skin cancer. Due to multiple, potential underlying molecular tumor aberrations, clinical treatment protocols are not well-defined. This study presents multisite molecular heterogeneity profiles of human BCC based on RNA and proteome profiling. Three areas from lesions excised from 9 patients were analyzed. The focus was gene expression profiles based on proteome and RNA measurements of intra-tumor heterogeneity from the same patient and inter-tumor heterogeneity in nodular, infiltrative, and superficial BCC tumor subtypes from different patients. We observed significant overlap in intra- and inter-tumor variability of proteome and RNA expression profiles, showing significant multisite heterogeneity of protein expression in the BCC tumors. Inter-subtype analysis has also identified unique proteins for each BCC subtype. This profiling leads to a deeper understanding of BCC molecular heterogeneity and potentially contributes to developing new sampling tools for personalized diagnostics therapeutic approaches to BCC.

Clinico-pathological Spectrum of Primary Skin Malignancies in an Indian Tertiary Care Hospital

Background

Skin malignancies are the most common form of malignant disease in the western world, predominantly affecting older age groups. The majority of skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma, which account for more than 95% of total skin malignancies. However, in India, these constitute only 1-2% of all cancers. There is an increase in incidence in India over 10 years of period. There is scarcity of data on the clinico-pathological profile of these tumours from this geographical region.

Materials and Methods

This was a retrospective study conducted in a tertiary care teaching hospital in which archival records and histopathology sections of all patients of skin carcinomas diagnosed over a period of 5 years (January 2016 to December 2020) were analysed. The clinical parameters and histopathological features of the cases were analysed and correlated for any possible association.

Results

Out of the 230 skin malignancies studied, SCC constituted the most common type (n = 148), followed by BCC (n = 70) and malignant melanoma (n = 12). The tumour commonly presented in the 6th decade of life with slightly higher male preponderance (M: F =1.6:1). Sun-exposed areas were the most common sites, and the common presentations included non-healing ulcer, fungating/cauliflower/polypoidal growth, and hyperpigmented or nodular plaque. In SCC, previous history of diabetes and burns was noted in 10% and 3.4% of the patients, respectively.

Conclusion

SCC is likely the most common histological type of skin malignancies in India. The clinico-pathological profile of skin malignancies of patients depends on multiple factors, notably the skin colour and the geographical location.

Polarimetric imaging combining optical parameters for classification of mice non-melanoma skin cancer tissue using machine learning

Polarimetric imaging systems combining machine learning is emerging as a promising tool for the support of diagnosis and intervention decision-making processes in cancer detection/staging. A present study proposes a novel method based on Mueller matrix imaging combining optical parameters and machine learning models for classifying the progression of skin cancer based on the identification of three different types of mice skin tissues: healthy, papilloma, and squamous cell carcinoma. Three different machine learning algorithms (K-Nearest Neighbors, Decision Tree, and Support Vector Machine (SVM)) are used to construct a classification model using a dataset consisting of Mueller matrix images and optical properties extracted from the tissue samples. The experimental results show that the SVM model is robust to discriminate among three classes in the training stage and achieves an accuracy of 94 % on the testing dataset. Overall, it is provided that polarimetric imaging systems and machine learning algorithms can dynamically combine for the reliable diagnosis of skin cancer.

The dermatologist's guide to beards: a review of structure, function, care and pathology

Facial hair is a commonly desired feature for many individuals. Despite a breadth of dermatology literature covering strategies for removing facial hair, there are no known articles summarizing strategies for facial hair growth or reviewing common facial hair pathologies. Here, we assess Google Trends to describe significant increases in search terms related to facial hair growth and maintenance over the last decade, suggesting an increased public interest in this topic. Next, we review ethnic differences that may affect facial hair distribution, growth, and predisposition to certain facial hair pathologies. Lastly, we review studies on agents used for facial hair growth and review common facial hair pathologies.

Skin Cancer and Hydrochlorothiazide: Novel Population-Based Analyses Considering Personal Risk Factors Including Race/Ethnicity

BACKGROUND

Hydrochlorothiazide, a common antihypertensive, has photosensitive properties, potentially increasing skin cancer risk. We evaluated melanoma and nonmelanoma skin cancer among hydrochlorothiazide users with 3 different cohorts as each allows assessment of different potential cofounders/effect modifiers, including race/ethnicity.

METHODS

We built 3 cohorts using IBM MarketScan Research Databases: Commercial and Encounters (>3.5 million individuals, 2010-2018), a subcohort with health risk assessment respondents (415, 330), and Medicaid (509, 767, 2011-2017). Adults (aged 18+ years) entered the respective cohort with a first-filled prescription (cohort entry) for hydrochlorothiazide (the exposure of interest) or angiotensin-converting enzyme (ACE) inhibitors (the active comparator), with ≥12 months of continuous enrollment with medical/pharmacy coverage at baseline. We excluded those who used hydrochlorothiazide/ACE inhibitor (including fixed-dose combination products) 12 months before cohort entry and those with prior skin cancer, HIV, or organ transplant. We compared the risk for hydrochlorothiazide versus ACE inhibitor using multivariate proportional hazards regression.

RESULTS

Baseline characteristics were similar, aside from more Black individuals among hydrochlorothiazide users (43.3% [95% CI, 43.0%-43.6%]) than ACE inhibitor users (28.1% [95% CI, 27.9%-28.3%]). The hazard ratio (95% CI) for nonmelanoma skin cancer related to hydrochlorothiazide (versus ACE inhibitor) was 0.96 (0.91-1.00) in the Commercial cohort, 1.01 (0.77-1.32) for the health risk assessment subcohort, and 1.33 (0.77-2.29) for Medicaid. For melanoma, the respective hazard ratios were 1.07 (0.95-1.20), 0.85 (0.43-1.67), and 0.93 (0.51-1.67), respectively.

CONCLUSIONS

Our evaluation using 3 different approaches, including adjustment for race/ethnicity, did not establish a clear difference between hydrochlorothiazide and ACE inhibitor in terms of skin cancer risk.

Real-World Experience with Cemiplimab Treatment for Advanced Cutaneous Squamous Cell Carcinoma-A Retrospective Single-Center Study

BACKGROUND

The systemic treatment of advanced cutaneous squamous cell carcinoma (cSCC) has seen significant developments in recent years. The anti-PD1 inhibitor cemiplimab has demonstrated efficacy in clinical trials, but real-world data are still limited. Here, we aimed to evaluate the efficacy and the safety of cemiplimab in a real-world clinical setting.

METHODS

A retrospective analysis was carried out for all patients who received at least two doses of cemiplimab at our department between February 2020 and January 2023. Progression-free survival (PFS), overall survival (OS), the objective response rate (ORR), the disease control rate (DCR) and adverse events (AEs) were evaluated.

RESULTS

Twenty-five patients were included with a median age of 78 (65-82) years. The median treatment duration was 48 (16-72) weeks. Five (20%) patients were immunocompromised. Sixteen patients (64%) developed AEs, including 36% serious AEs (SAEs) of grade ≥ 3. Six patients (24%) were withdrawn from treatment due to the occurrence of AEs. Among the 25 patients, 52% showed an objective response (3 complete and 10 partial responses), 76% had controlled disease and 24% experienced progression. Among the five immunocompromised patients, the ORR was 60%, while the DCR was 80%.

CONCLUSIONS

This retrospective real-world study revealed that locally advanced or metastatic cSCC could be effectively treated with cemiplimab even in elderly, polymorbid and immunocompromised patients.

Incidence, mortality and trends of cutaneous squamous cell carcinoma in Germany, the Netherlands, and Scotland

AIM OF THE STUDY

Cutaneous squamous cell carcinoma (cSCC) incidences are increasing but scarcely available separated. We analysed incidence rates of cSCC over three decades with an extrapolation to 2040.

METHODS

Cancer registries from the Netherlands, Scotland and two federal states of Germany (Saarland/Schleswig-Holstein) were sourced for separate cSCC incidence data. Incidence and mortality trends between 1989/90 and 2020 were assessed using Joinpoint regression models. Modified age-period-cohort models were applied to predict incidence rates up to 2044. Rates were age-standardised using the new European standard population (2013).

RESULTS

Age-standardised incidence rates (ASIR, per 100,000 persons per year) increased in all populations. The annual percent increase ranged between 2.4% and 5.7%. The highest increase occurred in the age groups ≥60 years, especially in men aged ≥80 years, with a three to 5-fold increase. Extrapolations up to 2044 showed an unrestrained increase in incidence rates in all countries investigated. Age-standardised mortality rates (ASMR) showed slight increases between 1.4 and 3.2% per year in Saarland and Schleswig-Holstein for both sexes and for men in Scotland. For the Netherlands, ASMRs remained stable for women but declined for men.

CONCLUSION

There was a continuous increase of cSCC incidence over three decades with no tendency for levelling-off, especially in the older populations as males ≥80 years. Extrapolations point to a further increasing number of cSCC up to 2044, especially among ≥60 years. This will have a significant impact on the current and future burden on dermatologic health care which will be faced with major challenges.

[S3 guideline on skin cancer prevention: evaluation and updating procedure]

BACKGROUND

Originally published in 2014, the S3 guideline "Prevention of skin cancer" is the first evidence-based guideline available exclusively for primary and secondary prevention, which summarizes interprofessional consented recommendations for skin cancer risk reduction and early detection. Due to the large number of new publications and expanding focus, an update was deemed necessary.

METHODS

After a structured needs assessment, key questions were prioritized. The resulting systematic literature search resulted in a three-stage screening process. Recommendations formulated in working groups were approved in a formal consensus process, taking into account conflicts of interest, and finalized after a 6‑week public consultation process.

RESULTS

The needs assessment identified "skin cancer screening" (60.1%), "individual risk avoidance behaviors" (44.20%), and "risk factors" (43.48%) as topics of greatest interest. The prioritization phase resulted in 41 new key questions. A total of 22 key issues were re-evaluated in an evidence-based manner using 93 publications. As part of comprehensive guideline restructuring, 61 recommendations were newly developed and 43 were modified. The consultation phase resulted in no changes to recommendations and 33 changes to background material.

CONCLUSION

The identified need for change resulted in extensive modification and redrafting of recommendations. As the target group "nononcology patients" cannot be identified via cancer registries or certification systems, no quality indicators can be derived from the guideline. To transfer the guideline to health care, innovative, addressee-specific concepts are required, which will be discussed and implemented during the preparation of the patient guideline.

Analyses of Basal and Squamous Cell Carcinoma Reported as an Adverse Drug Reaction and Comparison with Cases from the Cancer Registry from Germany

INTRODUCTION

In Germany, incidence rates of basal cell (BCC) and squamous cell carcinoma (SCC) rose significantly from 1998 to 2010. Ultraviolet (UV) light exposure, immunosuppressants and drugs with photosensitising potential are known to increase the risk to develop BCC and SCC. The aim of our study was to analyse the adverse drug reaction (ADR) reports from Germany referring to BCC and SCC and to compare them to BCC and SCC occurring in the general population.

METHODS

We analysed all validated spontaneous ADR reports referring to BCC (n = 191) and SCC (n = 75) from Germany contained in the European ADR database EudraVigilance prior to 6 March 2019. These reports were compared to 1,267,210 BCC and 476,903 SCC cases from the German Centre for Cancer Registry Data recorded from 2006 to 2018.

RESULTS

The number of BCC and SCC reports as well as the BCC and SCC incidences in the registry increased in the analysed time period. Patients with drug-associated BCC (60 years) and SCC (64 years) were younger than patients with BCC (72 years) and SCC (76 years) in the registry. In 57.1 and 60.0% of BCC and SCC reports immunosuppressants were reported as suspected. The reported suspected drug was assumed to possess a photosensitising potential in 41.9 and 44.0% of BCC and SCC reports.

CONCLUSIONS

In Germany, drug-associated BCC and SCC occurred at a younger age than in the general population. The results underline the necessity for skin cancer screening of patients treated with immunosuppressants or with drugs with photosensitising potential.

Prevalence of and Associated Factors for Eyelid Cancer in the American Academy of Ophthalmology Intelligent Research in Sight Registry

PURPOSE

To estimate the prevalence of eyelid cancers in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry and evaluate the associated factors.

DESIGN

Retrospective IRIS Registry database study.

PARTICIPANTS

All patients in the IRIS Registry between December 1, 2010, and December 1, 2018, with International Classification of Disease, ninth and 10th revisions, codes for eyelid cancers (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], malignant melanoma [MM], sebaceous carcinoma/other specified malignant neoplasm [SBC], melanoma in situ [MIS], and unspecified malignant neoplasm [UMN]).

METHODS

The prevalence of each eyelid cancer type was estimated overall and by age group, sex, race, ethnicity, and smoking status. The associations between any eyelid cancer (AEC) or each cancer type and possible risk factors were examined using univariate and multivariate logistic regression models.

MAIN OUTCOME MEASURES

Prevalence of and associated factors for each eyelid cancer type.

RESULTS

There were 82 136 patients with eyelid cancer identified. The prevalence of AEC was 145.1 per 100 000 population. The cancer-specific prevalence ranged from 87.9 (BCC) to 25.6 (UMN), 11.1 (SCC), 5.0 (SBC), 4.1 (MM), and 0.4 (MIS) per 100 000 population. The prevalence of AEC and each cancer type increased with increasing age (all P < 0.0001), and the prevalence of AEC, BCC, SCC, and MM was higher in males (all P < 0.0001), MIS (P = 0.02). The prevalence of BCC, SCC, MM, SBC, and AEC was highest in Whites versus that in patients of any other race (all P < 0.0001). In the multivariate logistic regression model with associated risk factors (age, sex, race, ethnicity, and smoking status), AEC was associated with older age groups ([< 20 years reference {ref.}]; odds ratio [95% confidence interval]: 20-39 years: 3.35 [1.96-5.72]; 40-65 years: 24.21 [14.80-39.59]; and > 65 years: 42.78 [26.18-69.90]), male sex (female [ref.]; 1.40 [1.33-1.48]), White race (inverse associations with African Americans [0.12 {0.09-0.16}], Asians [0.19 {0.13-0.26}], others [0.59 {0.40-0.89}]), and ethnicity (non-Hispanic [ref.]; Hispanic: 0.38 [0.33-0.45]; unknown: 0.81 [0.75-0.88]). Active smoking (never smoker [ref.]) was associated with AEC (1.11 [1.01-1.21]), BCC (1.27 [1.23-1.31]), SCC (1.59 [1.46-1.73]), and MM (1.26 [1.08-1.46]).

CONCLUSIONS

This study reports the overall and cancer-specific prevalence of eyelid cancers using a large national clinical eye disease database. Smoking was found to be associated with AEC, BCC, SCC, and MM, which is a new observation. This epidemiologic profile of on-eyelid cancers is valuable for identifying patients at a higher risk of malignancy, allocating medical resources, and improving cancer care.

New AI-algorithms on smartphones to detect skin cancer in a clinical setting-A validation study

BACKGROUND AND OBJECTIVES

The incidence of skin cancer is rising worldwide and there is medical need to optimize its early detection. This study was conducted to determine the diagnostic and risk-assessment accuracy of two new diagnosis-based neural networks (analyze and detect), which comply with the CE-criteria, in evaluating the malignant potential of various skin lesions on a smartphone. Of note, the intention of our study was to evaluate the performance of these medical products in a clinical setting for the first time.

METHODS

This was a prospective, single-center clinical study at one tertiary referral center in Graz, Austria. Patients, who were either scheduled for preventive skin examination or removal of at least one skin lesion were eligible for participation. Patients were assessed by at least two dermatologists and by the integrated algorithms on different mobile phones. The lesions to be recorded were randomly selected by the dermatologists. The diagnosis of the algorithm was stated as correct if it matched the diagnosis of the two dermatologists or the histology (if available). The histology was the reference standard, however, if both clinicians considered a lesion as being benign no histology was performed and the dermatologists were stated as reference standard.

RESULTS

A total of 238 patients with 1171 lesions (86 female; 36.13%) with an average age of 66.19 (SD = 17.05) was included. Sensitivity and specificity of the detect algorithm were 96.4% (CI 93.94-98.85) and 94.85% (CI 92.46-97.23); for the analyze algorithm a sensitivity of 95.35% (CI 93.45-97.25) and a specificity of 90.32% (CI 88.1-92.54) were achieved.

DISCUSSION

The studied neural networks succeeded analyzing the risk of skin lesions with a high diagnostic accuracy showing that they are sufficient tools in calculating the probability of a skin lesion being malignant. In conjunction with the wide spread use of smartphones this new AI approach opens the opportunity for a higher early detection rate of skin cancer with consecutive lower epidemiological burden of metastatic cancer and reducing health care costs. This neural network moreover facilitates the empowerment of patients, especially in regions with a low density of medical doctors.

REGISTRATION

Approved and registered at the ethics committee of the Medical University of Graz, Austria (Approval number: 30-199 ex 17/18).

Trends in keratinocyte skin cancer incidence, mortality and burden of disease in 33 countries between 1990 and 2017

BACKGROUND

Keratinocyte cancers (KCs) are the most common type of cancer in the White population worldwide, with associated high healthcare costs. Understanding the epidemiological trends for KCs, namely basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (SCCs), is required to assess burden of disease, project future trends and identify strategies for addressing this pressing global health issue.

OBJECTIVES

To report trends in BCC and SCC incidence, and SCC mortality and disability-adjusted life-years (DALYs).

METHODS

An observational study of the Global Burden of Disease (GBD) database between 1990 and 2017 was performed. European Union countries and other selected high-income countries, including the UK and the USA, classified as having high-quality mortality data, were included. Annual age-standardized incidence rates (ASIRs), age-standardized death rates (ASDRs) and DALYs for each country were obtained from the GBD database. Trends were described using joinpoint regression analysis.

RESULTS

Overall, 33 countries were included. For both BCC and SCC in 2015-2017, the highest ASIRs were observed in the USA and Australia. Males had higher ASIRs than females at the end of the observation period in all countries for SCC, and in all countries but two for BCC. In contrast, the highest ASDRs for SCC were observed in Australia and Latvia for males, and in Romania and Croatia for females. The highest DALYs for SCC for both sexes were seen in Australia and Romania. Over the observation period, there were more countries demonstrating decreasing trends in mortality than in incidence, and disparities were observed between which countries had comparatively high mortality rates and which had high incidence rates. Overall reductions in SCC DALYs were observed in 24 of 33 countries for males, and 25 countries for females.

CONCLUSIONS

Over the past 27 years, although trends in SCC incidence have risen in most countries, there is evidence that mortality rates have been decreasing. Burden of disease as assessed using DALYs has decreased in the majority of countries. Future work will explore potential explanatory factors for the observed disparity in trends in SCC incidence and mortality.

The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center

Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients' features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options.

Anticancer acumens of three Annona species: a proportional review

INTRODUCTION

Cumulative pattern of cancer could be seen in day-to-day life with each passing year and, it is becoming a great matter of concern especially to the scientific community worldwide. Alternative treatment methods for various types of cancer are in place and, being continuously worked out. Plant-derived natural substances have shown great results in combating cancer in comparison to chemo and radiotherapies which are toxic besides having serious side effects. In continuation, Annona species, native to America, Africa, Asia and Australia have been used in folk medicines and, are reported to have many anti-carcinogenic substances.

METHODS

For a prudent understanding of Annona species against various cancers, comparative investigation and analysis of three species viz., A. cherimola, A. muricata, and A. squamosa was undertaken through a detailed review of the in-attendance subject. The major scientific biomedical literature databases were consulted and the information available from 2011 until January 2021 was taken into account.

RESULTS

Studies on anti-cancer activities along with the thorough analysis of the findings and the pieces of evidence supporting their anti-proliferative, apoptosis, G₁ cell cycle arrest and cytotoxic effects are described. A. muricata displayed maximum number of anti-cancer activities being revealed by most of its parts with the lowest IC₅₀ values against various cancer cell lines compared to A. cherimola and A. squamosa. On account of the findings, it is advocated that, further detailed studies on anti-cancer explorations of Annona species could be proved fruitful in paving new and innovative methodologies for novel anti-cancer drug discovery and development.

Epidemiology of Merkel Cell Polyomavirus Infection and Merkel Cell Carcinoma

Merkel cell polyomavirus (MCPyV) is a ubiquitous virus replicating in human dermal fibroblasts. MCPyV DNA can be detected on healthy skin in 67−90% of various body sites, and intact virions are regularly shed from the skin. Infection occurs early in life, and seropositivity increases from 37 to 42% in 1- to 6-year-olds to 92% in adults. Merkel cell carcinoma (MCC) is a rare but very aggressive neuroendocrine tumor of the skin. It develops mainly on sun-exposed areas as a fast-growing, reddish nodule. Two MCC entities exist: about 80% of MCC are MCPyV-associated. Tumorigenesis is driven by viral integration into the host genome and MCPyV oncogene expression. In MCPyV-negative MCC, UV radiation causes extensive DNA damage leading to the deregulation of the cell cycle. In recent decades, MCC incidence rates have increased worldwide, e.g., in the United States, from 0.15 in 1986 to 0.7/100,000 in 2016. Risk factors for the development of MCC include male sex, older age (>75 years), fair skin, intense UV exposure, and immunosuppression. Projections suggest that due to aging populations, an increase in immunosuppressed patients, and enhanced UV exposure, MCC incidence rates will continue to rise. Early diagnosis and prompt treatment are crucial to reducing high MCC morbidity and mortality.

De Novo Skin Neoplasms in Liver-Transplanted Patients: Single-Center Prospective Evaluation of 105 Cases

Background and Objectives: Solid-organ transplant recipients (SOTRs) are notably considered at risk for developing cutaneous malignancies. However, most of the existing literature is focused on kidney transplant-related non-melanoma skin cancers (NMSCs). Conflicting data have been published so far on NMSC incidence among liver transplant recipients (LTRs), and whether LTRs really should be considered at lower risk remains controversial. The aim of the present study was to prospectively collect data on the incidence of cutaneous neoplasms in an LTR cohort. Materials and Methods: All LTRs transplanted at the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit of Modena University Hospital from October 2015 to June 2021 underwent a post-transplant periodic skin check at the Dermatology Unit according to our institutional integrated care pathway. Data on the presence of cutaneous malignant and premalignant lesions were collected at every timepoint. Results: A total of 105 patients were enrolled in the present study. Nearly 15% of the patients developed cutaneous cancerous and/or precancerous lesions during the follow-up period. Almost half of the skin cancerous lesions were basal cell carcinomas. Actinic keratoses (AKs) were observed in six patients. Four patients developed in situ squamous cell carcinomas, and one patient was diagnosed with stage I malignant melanoma. Otherwise, well-established risk factors for the occurrence of skin tumors, such as skin phototype, cumulative sun exposure, and familial history of cutaneous neoplasms, seemed to have no direct impact on skin cancer occurrence in our cohort, as well as an immunosuppressive regimen and the occurrence of non-cutaneous neoplasms. Conclusions: Close dermatological follow-up is crucial for LTRs, and shared protocols of regular skin checks in this particular subset of patients are needed in transplant centers.

Skin cancer risk factors among Black South Africans-The Johannesburg Cancer Study, 1995-2016

BACKGROUND

The Black population has lower skin cancer incidence compared to White, Indian/Asian, and Mixed-race populations in South Africa; however, skin cancer still exists in the Black population. The aim of this study is to identify risk factors associated with skin cancer among Black South Africans.

MATERIALS AND METHODS

A case-control study was conducted. Cases were patients with keratinocyte cancers (KCs) and/or melanoma skin cancers (MSCs) and controls were cardiovascular patients. Sociodemographic exposures, environmental health variables, smoking, and HIV status were assessed. Stepwise logistic regression was used to identify risk factors associated with KCs and MSCs.

RESULTS

The KCs histological subtypes showed that there were more squamous cell carcinomas (SCCs) (78/160 in females, and 72/160 in males) than basal cell carcinomas (BCCs). The SCC lesions were mostly found on the skin of the head and neck in males (51%, 38/72) and on the trunk in females (46%, 36/78). MSC was shown to affect the skin of the lower limbs in both males (68%, 27/40) and females (59%, 36/61). Using females as a reference group, when age, current place of residency, type of cooking fuel used, smoking, and HIV status were adjusted for, males had an odds ratio (OR) of 2.04 for developing KCs (confidence interval [CI]: 1.08-3.84, p = .028). Similarly, when age, current place of residency, and place of cooking (indoors or outdoors) were adjusted for, males had an OR of 2.26 for developing MSC (CI: 1.19-4.29, p = .012).

CONCLUSIONS

Differences in the anatomical distribution of KCs by sex suggest different risk factors between sexes. There is a positive association between being male, smoking, rural dwelling, and a positive HIV status with KCs and being male and rural dwelling with MSC. The rural dwelling was a newly found association with skin cancer and warrants further investigation.

Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline - Update 2022

Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. It is found predominantly in white populations and risk factors include advanced age, ultraviolet exposure, male sex, immunosuppression, such as AIDS/HIV infection, haematological malignancies or solid organ transplantation, and Merkel cell polyomavirus infection. MCC is an aggressive tumour with 26% of cases presenting lymph node involvement at diagnosis and 8% with distant metastases. Five-year overall survival rates range between 48% and 63%. Two subsets of MCC have been characterised with distinct molecular pathogenetic pathways: ultraviolet-induced MCC versus virus-positive MCC, which carries a better prognosis. In both subtypes, there are alterations in the retinoblastoma protein and p53 gene structure and function. MCC typically manifests as a red nodule or plaque with fast growth, most commonly on sun exposed areas. Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. For localised MCC, first-line treatment is surgical excision with postoperative margin assessment followed by adjuvant radiation therapy (RT). Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC. Chemotherapy can be used when patients fail to respond or are intolerant for anti-PD-(L)1 immunotherapy or clinical trials.

Targeting Microenvironment of Melanoma and Head and Neck Cancers in Photodynamic Therapy

Background:

Photodynamic therapy (PDT), in comparison to other skin cancers, is still far less effective for melanoma, due to the strong absorbance and the role of melanin in cytoprotection. The tumour microenvironment (TME) has a significant role in tumour progression, and the hypoxic TME is one of the main reasons for melanoma progression to metastasis and its resistance to PDT. Hypoxia is also a feature of solid tumours in the head and neck region that indicates negative prognosis.

Objective:

The aim of this study was to individuate and describe systematically the main strategies in targeting the TME, especially hypoxia, in PDT against melanoma and head and neck cancers (HNC), and assess the current success in their application.

Methods:

PubMed was used for searching, in MEDLINE and other databases, for the most recent publications on PDT against melanoma and HNC in combination with the TME targeting and hypoxia.

Results:

In PDT for melanoma and HNC, it is very important to control hypoxia levels, and amongst the different approaches, oxygen self-supply systems are often applied. Vascular targeting is promising, but to improve it, optimal drug-light interval, and formulation to increase the accumulation of the photosensitiser in the tumour vasculature, have to be established. On the other side, the use of angiogenesis inhibitors, such as those interfering with VEGF signalling, is somewhat less successful than expected and needs to be further investigated.

Conclusion:

The combination of PDT with immunotherapy by using multifunctional nanoparticles continues to develop and seems to be the most promising for achieving a complete and lasting antitumour effect.

A SHort course Accelerated RadiatiON therapy (SHARON) dose-escalation trial in older adults head and neck non-melanoma skin cancer

OBJECTIVES

To assess feasibility and safety of a SHort-course Accelerated RadiatiON therapy (SHARON) regimen, in the treatment of non-melanoma skin cancers (NMSC) in older patients.

METHODS

Old patients (age ≥ 80 years) with histological confirmed non-melanoma skin cancers were enrolled. The primary endpoint was to determine the maximum tolerated dose (MTD). Radiotherapy regimen was based on the delivery of four radiotherapy fractions (5 Gy per fraction) with a twice daily fractionation in two consecutive days. Three different level of dose were administered: 20 Gy (one cycle), 40 Gy (two cycles) and 60 Gy (three cycles).

RESULTS

Thirty patients (median age: 91 years; range: 80-96) were included in this analysis. Among fourteen patients who completed the one cycle, only one (7%) experimented acute G4 skin toxicity. Twelve patients reported an improvement or resolution of baseline symptoms (overall palliative response rate: 85.8%). Nine and seven patients underwent to two and three RT cycles, respectively: of these, no G3 toxicities were recorded. The overall response rate was 100% when three cycles were delivered. The overall six-month symptom-free survival was 78.7% and 77.8% in patients treated with one course and more courses, respectively.

CONCLUSIONS

Short-course accelerated radiotherapy in older patients with non-melanoma skin cancers is well tolerated. High doses seem to be more effective in terms of response rate.

ADVANCES IN KNOWLEDGE

This approach could represent an option for older adults with NMSC, being both palliative (one course) or potentially curative (more courses) in the aim, accordingly to the patient's condition.

Cancer incidence and mortality and risk factors in member countries of the " Belt and Road " initiative

BACKGROUND

At present, "Belt and Road" ("B&R") member states (accounting for about 61.78% of the world's population) face different types of cancer threats to varying degrees. We analyzed the incidence and mortality and risk factors of cancer in the member countries of the "B&R" to explore the basis of health and medical cooperation between countries and provide a foundation for formulating cancer prevention and control policies for building a healthy "B&R."

METHODS

Data were derived from the Global Cancer Observatory and Cancer Country Profiles in 2020. Incidence and mortality were age-standardized rates (ASRs). Population attributable fractions (PAFs) was applied to measure risk factors of cancers in the "B&R" countries. The mortality-to-incidence ratio (MIR) was calculated by dividing the mortality rate by the incidence rate.

RESULTS

A total of 26 cancers were included in the study. Lung, breast, colorectal, stomach, liver, prostate, cervical, esophageal, thyroid, and uterine cancers were the most common and highest in age-standardized mortality in the "B&R" countries. For men, Hungary had the highest cancer age-standardized incidence and mortality (ASR, 289.3 per 100,000 and ASR, 235.7 per 100,000, respectively), followed by Latvia (ASR, 288.6 per 100,000 and ASR, 196.5 per 100,000, respectively). In females, the highest incidence rates were estimated in Greece (ASR, 238.7 per 100,000), and the highest mortality rate was Brunei (ASR, 192.3 per 100,000). All countries were in the middle or high HDI range, with about half (46.88%) of countries achieving high HDI, mostly in Central and Eastern Europe (13 countries) and West Asia (10 countries). The United Arab Emirates had the highest MIR in male and female (1.59 vs 2.19). Tobacco products, infectious factors, and ultraviolet rays were the three main cancer risk factors in the "B&R" countries.

CONCLUSION

The overall burden of cancer in the countries along the "B&R" remains substantial, while the corresponding cancer prevention and control policies need to be improved. Strengthening health cooperation among member countries will contribute to a joint response to the risks and challenges posed by cancer.

Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 1: cutaneous tumor diseases

Epidemiological data are of great importance for the identification of health care needs, the detection of gaps in care, the development of targeted prevention measures, and for the optimization of resource allocation. The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. The present part 1 of the publication series deals with tumor diseases of the skin. The results on non-infectious (part 2) and infectious skin diseases (part 3) form the other parts of this publication series. A systematic search of the literature spanning the last 15 years was conducted using the PubMed/MEDLINE database. With the aim of including all dermatologic diseases, a diagnostic list was developed based on the ICD-11 catalogue. This list included 1,347 skin diseases and formed the basis for the search. The literature search yielded 4,650 publications. After two-stage screening, 72 studies on 43 different skin diseases were included in the synthesis. Among them were 30 publications on cutaneous tumor diseases, the majority was related to malignant melanoma. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. In terms of study characteristics, a high heterogeneity was found for the different skin diseases. Even though the methodology of the included epidemiological studies varied considerably, the usefulness of these epidemiological data is extremely wide-ranging. Thus, this work can serve as a reference for various epidemiological questions.

Incidence Trends and Survival Prediction of Malignant Skin Cancer: A SEER-Based Study

Purpose

Methods

Results

Conclusion

Effect of plasticizers on drug-in-adhesive patches containing 5-fluorouracil

Topical patches containing 5-fluorouracil (5-FU) are a feasible alternative to overcome the shortcomings of commercial cream for the treatment of non-melanoma skin cancer (NMSC). Plasticizers are a critical component of drug-in-adhesive (DIA) patches as they can significantly affect the mechanical, adhesive and drug release characteristics of the patches. Eudragit® E (EuE) is a methacrylate-based cationic copolymer capable of producing flexible and adhesive films for topical application. In this study, the effect of plasticizers on the mechanical, adhesive and 5-FU release characteristics of EuE-based patches was comprehensively evaluated. While the elongation at break (%) and adhesion of the films were significantly increased with increasing triacetin, dibutyl sebacate (DBS) and triethyl citrate (TEC) concentrations, the tensile strength showed an inverse relationship. EuE plasticized with 40% triacetin, 30% DBS or 40% w/w TEC produced elastic and adhesive films most suitable for topical application. In vitro release studies of the 5-FU-loaded patches demonstrated an initial burst release pattern during the first 10 min followed by a slow release over 120 min. In summary, this study provides important information on effect of plasticizers for preparation of EuE-based patches with desired mechanical, adhesive and release characteristics of 5-FU towards their potential application in the treatment of NMSC.

The effects of UVB irradiance on aberrant epidermal proliferation: Novel insights on how to improve currently available sunscreens

AIMS

Sunscreen use, which prolonged the time required to develop sunburn by reducing the irradiance (mW/cm²) of the UVB radiation, is thought to protect the skin from developing cancers. Recently, in addition to fluence (mJ/cm²), irradiance of the UVB radiation was demonstrated to play an important role leading to photocarcinogenesis of the skin. After equivalent fluence of UVB exposure, enhanced aberrant keratinocyte proliferation contributes significantly to the photocarcinogenic capacity of low irradiance (LI) UVB as compared to its high irradiance (HI) UVB counterpart. However, the mechanism involved remains unclear.

MAIN METHODS

Relevant cell and animal models were employed to investigate the effects of equivalent UVB fluence administered at HI or LI on keratinocyte proliferation. Additionally, the mechanisms involved were also explored.

KEY FINDINGS

We found that at equivalent fluence, LIUVB induces significantly higher reactive oxidative species (ROS) production, cell proliferation, as well as phosphorylated AKT (pAKT) expression in both cell and animal models as compare to its HIUVB counterpart. Pretreating cultured keratinocytes with antioxidant or AKT inhibitor significantly reduced the UVB-induced ROS, cell proliferation, and pAKT expression. Additionally, these pretreatments abrogate the difference between the LI and HIUVB treated keratinocytes. Similar findings were noted using animal model treated with AKT inhibitor.

SIGNIFICANCE

In summary, at equivalent fluence, LIUVB induces significantly more aberrant epidermal proliferation via enhanced ROS and pAKT signaling. Reducing UVB-induced AKT phosphorylation presents a novel strategy to improve the protective capacity of the currently available sunscreens.

Cemiplimab in an Elderly Frail Population of Patients With Locally Advanced or Metastatic Cutaneous Squamous Cell Carcinoma: A Single-Center Real-Life Experience From Italy

Background

Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer whose incidence is growing parallel to the lengthening of the average lifespan. Cemiplimab, an antiPD-1 monoclonal antibody, is the first approved immunotherapy for patients with locally advanced CSCC (laCSCC) or metastatic CSCC (mCSCC) thanks to phase I and II studies showing high antitumor activity and good tolerability. Nevertheless, at present, very few data are available regarding cemiplimab in real-life experience and in frail, elderly, and immunosuppressed patients as well as regarding biomarkers able to predict response so as to guide therapeutic choices.

Patients and Methods

We built a retroprospective cohort study including 30 non-selected patients with laCSCC (25) and mCSCC (five) treated with cemiplimab from August 2019 to November 2020. Clinical outcomes, toxicity profile, and correlations with disease, patients, and peripheral blood parameters are explored.

Results

The median age was 81 years (range, 36-95), with 24 males and five patients having an immunosuppressive condition, while the frailty prevalence was 83% based on index derived from age, Eastern Cooperative Oncology Group performance status, and Charlson Comorbidity Index. We reported 23 responses (76.7%) with nine complete responses (30%). A statistically significant higher response rate was observed in head and neck primary tumors and in patients with hemoglobin level >12 g/dl. No difference was observed with respect to frailty, median age, sex, and body mass index. The baseline low neuthophil/lymphocyte ratio and low platelet/lymphocyte ratio resulted to be also correlated with a better response. Moreover, lymphocyte, neutrophil, and monocyte behaviors had an opposite trend in responders and non-responders. An overall response was reported in four of five immunosuppressed patients. Seventeen patients (57.6%) have an ongoing response and are still alive. Six responders had interrupted treatment (two for toxicity and four for personal choice) but maintained their response. The treatment was well tolerated by the majority of patients. The most common adverse events were fatigue in seven patients (23.3%) and skin toxicity in 10 patients (33.3%), including pruritus in six patients, rash in three patients, and bullous erythema in one patient.

Conclusions

In our real-life experience, cemiplimab showed a high antitumor activity with acceptable safety profile similar to those in trials with selected patients. Moreover, its antitumor activity resulted to be not impaired in very elderly patients and in those with immunocompromised status.

Micronodular basal cell carcinoma of the scrotum: a case report and review of the literature

Introduction

Basal cell carcinoma is the most common nonmelanotic skin cancer. It has variable clinical and histological subtypes that vary in their aggressiveness and liability to recurrence and metastasis. Chronic ultraviolet radiation exposure is considered to be the main risk factor for developing basal cell carcinoma; therefore, it typically arises on sun-exposed skin, mainly the head and neck.

Case presentation

We present the case of a 55-year-old Caucasian male who presented with a lesion on the scrotum for 2 years. The lesion was clinically presumed benign and initially treated with curettage. Microscopic examination revealed an incompletely resected micronodular basal cell carcinoma with sebaceous differentiation. Therefore, a second excisional biopsy was performed to completely excise the incidentally discovered malignant tumor.

Conclusion

We report the first case of micronodular basal cell carcinoma arising on the scrotum. The goal of our article is to draw clinicians’ attention to the possible involvement of unexposed skin with basal cell carcinoma, and we highlight the importance of accurate diagnosis and prompt treatment due to the aggressive nature of micronodular basal cell carcinoma.

Incidence and mortality rates of keratinocyte carcinoma from 1998-2017: a population-based study of sex differences in Ontario, Canada

Background:

Keratinocyte carcinoma is the most common malignant disease, but it is not captured in major registries. We aimed to describe differences by sex in the incidence and mortality rates of keratinocyte carcinoma in Ontario, Canada.

Methods:

We conducted a population-based retrospective study of adults residing in Ontario between Jan. 1, 1998, and Dec. 31, 2017, using linked health administrative databases. We identified the first diagnosis of keratinocyte carcinoma using a validated algorithm of health insurance claims, and deaths related to keratinocyte carcinoma from death certificates. We calculated the incidence and mortality rates of keratinocyte carcinoma, stratified by sex, age and income quintile. We evaluated trends using the average annual percentage change (AAPC) based on joinpoint regression.

Results:

After decreasing from 1998 to 2003, the incidence rate of keratinocyte carcinoma increased by 30% to 369 per 100 000 males and 345 per 100 000 females in 2017 (AAPC 1.9%, 95% confidence interval [CI] 1.7 to 2.1 from 2003 to 2017). The incidence rate was higher in females younger than 55 years, but higher in males aged 55 years or older. Between 2008 and 2017, the incidence rate rose faster in females than males aged 45–54 years (AAPC 1.2% v. 0.5%, p = 0.01) and 55–64 years (1.2% v. 0.1%, p < 0.01). The incidence was higher in males than females in the higher income quintiles. Between 1998 and 2017, the mortality rate of keratinocyte carcinoma was 1.8 times higher in males than females, on average, and rose 4.8-fold overall (AAPC 8.9%, 95% CI 6.4 to 11.4 in males; 8.0%, 95% CI 5.3–10.8 in females).

Interpretation:

The population burden of keratinocyte carcinoma is growing, and the incidence and mortality rates rose disproportionately among certain sex- and age-specific groups. This warrants further investigation into causal factors and renewed preventive public health measures.

Systematic literature review of current treatments for stage I-III Merkel cell carcinoma

Aim: There is a need to evaluate current treatments for stages I-III of Merkel cell carcinoma (MCC). Materials & methods: A systematic literature review was conducted to understand how patients with stage I-III MCC are treated and assess efficacy, safety, health-related quality of life and economic impact of current therapies. Embase was searched using the following inclusion criteria: publications from 2014 to 2019, in English, with adult patients (≥18 years) with early-stage MCC (i.e., stages I-III) and any interventions/comparators. Publications were excluded if they included only patients with stage IV MCC, had no distinction between early and advanced or metastatic MCC or had no extractable data. Results: A total of 18 retrospective studies were included. Few studies had evidence that surgery plus adjuvant radiotherapy significantly increased survival versus surgery alone in early MCC. Limited safety data were reported in three studies. None of the studies reported data on health-related quality of life or economic impact of treatment in patients with early-stage MCC. Conclusion: Although surgery plus adjuvant radiotherapy was a common treatment, no clear standard of care exists for stages I-III MCC and treatment outcomes need to be improved. All studies were retrospective with a high variability in sample sizes; hence, findings should be interpreted with caution.

Temporal trends in the incidence rates of keratinocyte carcinomas from 1978 to 2018 in Tasmania, Australia: a population-based study

OBJECTIVES

We described incidence trends of keratinocyte carcinomas (KCs)-namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-in the Australian state of Tasmania.

METHODS

We identified histologically confirmed KCs within the Tasmanian Cancer Registry (TCR) and conducted assessments to ensure data quality. Age-standardised incidence rates were calculated for first (1985-2018) and annual KCs (1978-2018). Average annual percentage changes were computed using Joinpoint regression models.

RESULTS

The TCR is a reliable source of KC data. A total of 83,536 people were registered with a KC between 1978 and 2018. Age-standardised incidence rates of first KCs increased on average by 3% per annum for BCCs and 4% per annum for SCCs, reaching 363/100,000 and 249/100,000 in 2018, respectively. Age-standardised incidence rates of annual KCs increased on average by 5% per annum for BCCs and 6% per annum for SCCs, up to 891/100,000 and 514/100,000 in 2018, respectively. This increase was steeper for females than males and highest during the late 1980s and early 1990s. A change in trend around 2014 suggested that incidence rates have started to decline.

CONCLUSION

While the incidence of KCs in Tasmania increased substantially over 41 years, rates have recently plateaued and started to decline. The findings may reflect changes in sun exposure behaviours due to awareness campaigns, but high incidence rates in 2018 indicate that KCs still pose a substantial burden to this population.