Risk factors for early-onset basal cell carcinomas and the trend towards their female predominance

Photosensibilisierende Antihypertensiva und das Hautkrebsrisiko bei postmenopausalen Frauen: Photosensitizing antihypertensive medication and risk of skin cancer among postmenopausal women

Hintergrund

Es gibt nur wenige prospektive Studien, die die Dosis‐Wirkungs‐Beziehung zwischen der Anwendung einiger photosensibilisierender Antihypertensiva und Hautkrebs untersucht haben.

Patienten und Methodik

Anhand prospektiver Daten aus der Women's Health Initiative Observational Study untersuchten wir den Zusammenhang zwischen der Anwendung von Antihypertensiva und dem Risiko für nicht melanozytären Hautkrebs (NMSC) und dem Melanom bei postmenopausalen Frauen im Alter von 50–79 Jahren (n = 64 918). Dabei wurden multivariable Cox‐Regressionsmodelle (Proportional‐Hazard‐Modelle) verwendet und Hazard Ratios (HR) sowie 95%‐Konfidenzintervalle (KI) berechnet.

Ergebnisse

8777 NMSC und 1227 Melanom‐Fälle wurden beobachtet. Die Anwendung von Antihypertensiva (HR [95%‐KI]: 1,12 [1,07–1,18]), ACE‐Hemmern (1,09 [1,01–1,18]), Kalziumkanalblockern (1,13 [1,05–1,22]), Diuretika (1,20 [1,12–1,27]), Schleifendiuretika (1,17 [1,07–1,28]) und Thiaziden (1,17 [1,03–1,33]) war jeweils mit einem erhöhten NMSC‐Risiko assoziiert. Das NMSC‐Risiko stieg linear mit der Anwendung mehrerer Antihypertensiva (p‐Trend = 0,02) und mit zunehmender Anwendungsdauer (p‐Trend < 0,01) an. Antihypertensiva (1,15 [1,00–1,31]), Angiotensin‐II‐Rezeptorblocker (1,82 [1,05–3,15]) und Diuretika (1,34 [1,13–1,59]) waren jeweils mit einem erhöhten Melanomrisiko assoziiert. Zwischen der Anwendung von Antihypertensiva und der Melanom‐Inzidenz wurde eine Effektmodifikation durch Exposition gegenüber Sonnenlicht‐Exposition beobachtet (p‐Interaktion = 0,02).

Schlussfolgerungen

Die Anwendung von Antihypertensiva allgemein und einiger einzelner Klassen von Antihypertensiva ging mit einer erhöhten Inzidenz von NMSC und Melanomen einher, wobei eine Dosis‐Wirkungs‐Beziehung bestand.

Photosensitizing antihypertensive medication and risk of skin cancer among postmenopausal women

BACKGROUND

Few prospective studies exist with an evaluation of a dose-response relationship between use of some photosensitizing antihypertensive medications and skin cancer.

PATIENT AND METHODS

We used prospective data from the Women's Health Initiative Observational Study to investigate the association between antihypertensive use and risk of non-melanoma skin cancer (NMSC) and melanoma in postmenopausal women aged 50-79 years at baseline (n  =  64,918). Multivariable Cox proportional hazards regression models were used and hazard ratios (HRs) and 95 confidence intervals (CIs) were calculated.

RESULTS

8,777 NMSC and 1,227 melanoma cases were observed. Use of antihypertensives (HR [95% CI]: 1.12 [1.07-1.18]), ACE inhibitors (1.09 [1.01-1.18]), calcium channel blockers (1.13 [1.05-1.22]), diuretics (1.20 [1.12-1.27]), loop diuretics (1.17 [1.07-1.28]), and thiazides (1.17 [1.03-1.33]) were each associated with higher NMSC risk. NMSC risk linearly increased with use of multiple antihypertensives (p-trend  =  0.02) and with longer duration of use (p-trend < 0.01). Antihypertensives (1.15 [1.00-1.31]), angiotensin-II receptor blockers (1.82 [1.05-3.15]), and diuretics (1.34 [1.13-1.59]) were each associated with elevated melanoma risk. Effect modification by solar radiation exposure was found between antihypertensive use and incidence of melanoma (p-interaction  =  0.02).

CONCLUSIONS

Use of antihypertensives overall, and several individual classes thereof, were associated with higher incidence of NMSC and melanoma with dose-response relationship.

Clinical and dermoscopic variation of basal cell carcinoma according to age of onset and anatomic location: a multicenter, retrospective study

Basal cell carcinoma (BCC) is rare in young individuals and reported to possess different pathogenetic, clinical and histological features from late-onset BCC. However, the dermoscopic variability of BCC according to age of onset has not been investigated. Anatomic location was revealed to be associated with dermoscopic variation of BCC in Western population, but whether it applies to Asian population remains unknown. We evaluated the clinical and dermoscopic features of 448 BCCs and compared each feature by age of onset (age < 50/ > 50 years) and anatomic location. Early-onset BCCs occurred more frequently on non-sun-exposed sites (OR 3.28, P = 0.001) and were less pigmented than late-onset BCCs (P = 0.003). Blue-gray globules (OR 1.74, P = 0.037) and no vessels (OR 2.04, P = 0.021) were independently associated with early-onset BCCs, whereas arborizing telangiectasia (OR 0.30, P < 0.001), large blue-gray ovoid nests (OR 0.38, P < 0.001) and ulceration (OR 0.33, P < 0.001) were less common in early-onset BCCs. Scalp BCCs were significantly more pigmented than BCCs located elsewhere (P = 0.022). Superficial subtype (OR 5.90, P < 0.001), spoke-wheel areas (OR 4.78, P = 0.034), superficial erosions (OR 4.69, P = 0.003) and polymorph vessels (OR 6.86, P = 0.001) were independently associated with trunk BCCs, whereas nodular subtype (OR 5.48, P < 0.001) and arborizing telangiectasias (OR 3.64, P < 0.001) with BCCs on face and neck. Our findings suggest that age of onset and anatomic location are independent factors affecting the dermoscopic appearance of BCC.

Biomarkers found in the tumor interstitial fluid may help explain the differential behavior among keratinocyte carcinomas

Basal Cell Carcinomas (BCC) and cutaneous Squamous Cell Carcinomas (SCC) are the most frequent types of cancer, and both originate from the keratinocyte transformation, giving rise to the group of tumors called keratinocyte carcinomas (KC). The invasive behavior is different in each group of KC and may be influenced by their tumor microenvironment. The principal aim of the study is to characterize the protein profile of the Tumor Interstitial Fluid (TIF) of KC to evaluate changes in the microenvironment that could be associated with their different invasive and metastatic capabilities. We obtained TIF from 27 skin biopsies and conducted a label-free quantitative proteomic analysis comparing 7 BCCs, 16 SCCs, and 4 Normal Skins. A total of 2945 proteins were identified, 511 of them quantified in more than half of the samples of each tumoral type. The proteomic analysis revealed differentially expressed TIF-proteins that could explain the different metastatic behavior in both KC. In detail, the SCC samples disclosed an enrichment of proteins related to cytoskeleton, such as Stratafin and Ladinin1. Previous studies found their up-regulation positively correlated with tumor progression. Furthermore, the TIF of SCC samples was enriched with the cytokines S100A8/S100A9. These cytokines influence the metastatic output in other tumors through the activation of NF-kB signaling. According to this, we observed a significant increase in nuclear NF-kB subunit p65 in SCCs but not in BCCs. In addition, the TIF of both tumors was enriched with proteins involved in the immune response, highlighting the relevance of this process in the composition of the tumor environment. Thus, the comparison of the TIF composition of both KC provides the discovery of a new set of differential biomarkers. Among them, secreted cytokines such as S100A9 may help explain the higher aggressiveness of SCCs, while Cornulin is a specific biomarker for BCCs. Finally, the proteomic landscape of TIF provides key information on tumor growth and metastasis, which can contribute to the identification of clinically applicable biomarkers that may be used in the diagnosis of KC, as well as therapeutic targets.