Lifetime prevalence of non-melanoma and melanoma skin cancer in Australian recreational and competitive surfers

Pathogenic mechanisms and etiologic aspects of Mycobacterium avium subspecies paratuberculosis as an infectious cause of cutaneous melanoma

Infectious etiologies have previously been proposed as causes of both melanoma and non-melanoma skin cancer. This exploratory overview explains and presents the evidence for the hypothesis that a microorganism excreted in infected ruminant animal feces, Mycobacterium avium subspecies paratuberculosis (MAP), is the cause of some cases of cutaneous melanoma (CM). Occupational, residential, and recreational contact with MAP-contaminated feces, soil, sand, and natural bodies of water may confer a higher rate of CM. Included in our hypothesis are possible reasons for the differing rates and locations of CM in persons with white versus nonwhite skin, why CM develops underneath nails and in vulvar skin, why canine melanoma is an excellent model for human melanoma, and why the Bacille Calmette-Guérin (BCG) vaccine has demonstrated efficacy in the prevention and treatment of CM. The pathogenic mechanisms and etiologic aspects of MAP, as a transmittable agent underlying CM risk, are carefully deliberated in this paper. Imbalances in gut and skin bacteria, genetic risk factors, and vaccine prevention/therapy are also discussed, while acknowledging that the evidence for a causal association between MAP exposure and CM remains circumstantial.

Implementation of artificial intelligence for the detection of cutaneous melanoma within a primary care setting: prevalence and types of skin cancer in outdoor enthusiasts

Background

There is enthusiasm for implementing artificial intelligence (AI) to assist clinicians detect skin cancer. Performance metrics of AI from dermoscopic images have been promising, with studies documenting sensitivity and specificity values equal to or superior to specialists for the detection of malignant melanomas (MM). Early detection rates would particularly benefit Australia, which has the worlds highest incidence of MM per capita. The detection of skin cancer may be delayed due to late screening or the inherent difficulty in diagnosing early skin cancers which often have a paucity of clinical features and may blend into sun damaged skin. Individuals who participate in outdoor sports and recreation experience high levels of intermittent ultraviolet radiation (UVR), which is associated with the development of skin cancer, including MM. This research aimed to assess the prevalence of skin cancer in individuals who regularly participate in activities outdoors and to report the performance parameters of a commercially available AI-powered software to assess the predictive risk of MM development.

Methods

Cross-sectional study design incorporating a survey, total body skin cancer screening and AI-embedded software capable of predictive scoring of queried MM.

Results

A total of 423 participants consisting of surfers (n = 108), swimmers (n = 60) and walkers/runners (n = 255) participated. Point prevalence for MM was highest for surfers (6.48%), followed by walkers/runners (4.3%) and swimmers (3.33%) respectively. When compared to the general Australian population, surfers had the highest odds ratio (OR) for MM (OR 119.8), followed by walkers/runners (OR 79.74), and swimmers (OR 61.61) rounded out the populations. Surfers and swimmers reported comparatively lower lifetime hours of sun exposure (5,594 and 5,686, respectively) but more significant amounts of activity within peak ultraviolet index compared with walkers/runners (9,554 h). A total of 48 suspicious pigmented lesions made up of histopathology-confirmed MM (n = 15) and benign lesions (n = 33) were identified. The performance of the AI from this clinical population was found to have a sensitivity of 53.33%, specificity of 54.44% and accuracy of 54.17%.

Conclusions

Rates of both keratinocyte carcinomas and MM were notably higher in aquatic and land-based enthusiasts compared to the general Australian population. These findings further highlight the clinical importance of sun-safe protection measures and regular skin screening in individuals who spend significant time outdoors. The use of AI in the early identification of MM is promising. However, the lower-than-expected performance metrics of the AI software used in this study indicated reservations should be held before recommending this particular version of this AI software as a reliable adjunct for clinicians in skin imaging diagnostics in patients with potentially sun damaged skin.

Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes-A Narrative Review

Outdoor sports are associated with increased exposure to ultraviolet radiation, which may result in sunburn, solar damage, and skin cancers. Water and winter sports create additional adverse conditions, such as washing away sunscreen by water and reflection of UV rays by the water and snow. Sweating-increased skin photosensitivity and activity-induced immunosuppression are associated with a greater risk of developing skin cancers. In this review, we focus on a group of athletes and sports participants and analyze 62 articles concerning sun exposure during outdoor sports, the risk of developing skin cancer, and knowledge and behavior regarding photoprotection methods. Various practices have been linked to an increased risk of developing basal cell carcinoma (BCC), squamous cell carcinoma (SCC), malignant melanoma (MM), or UV-induced skin damage. Water sports and mountaineering increase the risk of BCC. Surfing and swimming are risk factors for SCC. Melanoma is more common in swimmers, surfers, and marathon runners. Photoprotection behaviors can reduce potential skin damage and skin cancers. Athletes' knowledge about the risk of malignant lesions was satisfactory, but despite the risks, outdoor sports participants seem not to protect themselves from the sun adequately.

Cross-sectional study of physical activity among long-term melanoma survivors and population controls

Physical activity has been associated with improved outcomes among cancer survivors of various malignancies; however, this topic is understudied among melanoma survivors. Our objective was to determine whether long-term melanoma survivors are less likely to meet American Cancer Society physical activity guidelines than non-melanoma population controls. We conducted a cross-sectional survey in 2015 to follow up participants from a case-control study of melanoma and population controls in Minnesota. The primary outcome was meeting American Cancer Society recommendations for healthy physical activity levels. Physical activity, sun protection practices and time spent outside were compared between survivors and controls using generalized linear regression models. Melanoma survivors (N = 724) and controls (N = 639) were similar with the exceptions of daily hours spent outside, sun protection scores, skin tone, and smoking status. Half (50.8%) of melanoma survivors reported meeting the physical activity guidelines, compared to 39.7% of controls (p < 0.0001), with an 11% (95% CI 0.05-0.17) difference after adjusting for potential confounders. While long-term melanoma survivors were more likely to meet American Cancer Society physical activity guidelines than population controls, nearly 50% did not meet recommendations. This finding is concerning given the known improvements in quality of life and survival among physically active cancer survivors. Opportunities remain to promote physical activity among melanoma survivors. Health communications that promote outdoor exercise, in particular, should include advice about sun protection.

Knowledge, Behaviour and Attitudes Related to Sun Exposure in Sportspeople: A Systematic Review

People who practice outdoor sports have an increased risk of skin cancer as they are exposed to high doses of ultraviolet (UV) radiation. Recent studies have shown that in many athletes, sun protection behaviours are inadequate, with the risk that this entails. The aim of this review is to collect the information published to date about the knowledge, attitudes and habits of athletes in relation to sun exposure and its risks. A systematic review was conducted using PubMed and Embase with the search algorithm "(skin cancer OR melanoma) AND (exercise OR sport OR athletes)". All studies analysing the knowledge, attitudes and habits of photoprotection in athletes were included. A total of 2,365 publications were found, of which 23 were selected, including a total of 10,445 sportspeople. The majority of participants declared their voluntary intention to tan and stated that the sun made them feel better, although they also showed concern about possible damage associated with UV radiation. In most studies, less than half of the participants made adequate use of photoprotective measures. In general, most athletes had a high level of knowledge regarding the risk of skin cancer associated with sun exposure. In conclusion, most athletes are aware of the risks associated with UV radiation but do not make adequate use of photoprotective cream. New training programs on photoprotection could help improve athletes' photoprotective behaviour, reducing the incidence of skin cancer and precancerous lesions in this population.

Surfing the waves: Environmental and socio-economic aspects of surf tourism and recreation

Marine ecosystems contribute to human well-being, e.g. through the promotion of nature-based recreational activities such as surfing, which is a benefit obtained from Cultural Ecosystem Services (CES). Our research objective is to identify the benefits and impacts associated to surfing, and who are the main affected subjects and/or objects, achieving a better understanding of the sustainability status of this recreational activity. To this end, a bibliometric study and systematic review was carried out for the period 1965-2021. Benefits and impacts were collated and grouped according to their dimensional focus and type of effects in 6 groups (3-dimensional focus × 2 type of effects). The results revealed that since the beginning of 21st century surfing research topics are growing and diversifying. This review shows that implications of surfing go beyond direct users (i.e., surfers) and has consequences in diverse dimensions (environmental, socio cultural and economic), involving many stakeholders (e.g., scientific, and local communities). Most of the pieces of evidence collated in this research were related with the people who practice the activity and its social implications (psychological benefits as main benefit and injuries as main impact). Following an interdisciplinary approach, we obtained a holistic understanding of the surfing activity, not only in terms of the different dimensions addressed but on the sectors of the society that obtain benefits or are impacted by the activity. All of them should be considered and integrated to guarantee the sustainable management of this CES benefit.

Sun Exposure and Photoprotection: Habits, Knowledge and Attitudes Among Elite Kitesurfers

Kitesurfing is one of many water sports that are growing in popularity throughout the world. In such sports, practitioners are exposed not only to direct sunlight but also to reflection from the water surface, which aggravates the impact of solar radiation on the skin. This study sought to analyse the photoprotection and photoexposure habits and knowledge of elite kitesurfers and their beliefs and attitudes in this respect. A sample of convenience of 72 male kitesurfers completed a validated questionnaire in full. By Fitzpatrick phototype, the most common classes were types I and II (69.4%). On average, kitesurfers had been practising their sport for 10.93 years, at a rate of 13.93 h per week. During the last sports season, 84.7% of respondents had suffered at least one sunburn, while 43.1% had been sunburned at least three times. The sun protection practice most commonly adopted was the use of sunscreen cream, which was used by 79.2% of respondents. Although 43.2% of respondents recognized to be worried about they might get skin cancer from the sun, 31.9% does not like using sunscreen and 44.4% like sunbathing. Regarding the respondents' knowledge of facts about sun exposure, the average rate of correct answers for the items evaluated was 66.9%. In conclusion, elite kitesurfers are potentially exposed to dangerous levels of UV radiation, which caused numerous sunburn episodes during the last sports season. It is necessary to raise these athletes' awareness of their risk of developing skin cancer and of the need to improve their sun protection and skin surveillance practices.

Point prevalence of non-melanoma and melanoma skin cancers in Australian surfers and swimmers in Southeast Queensland and Northern New South Wales

Background

Surfing and swimming are two popular outdoor aquatic activities in Australia with an estimated 2.7 million surfers and three million swimmers; however, these activities are associated with intermittent exposure to ultraviolet radiation. Our aim was to determine the point prevalence of pre-skin cancer (actinic keratosis (PSC)), non-melanoma (NMSC) and melanoma skin cancers (MSC) in Australian surfers and swimmers.

Methods

This cross-sectional study involved Australian surfers who completed a survey that included physiological demographics, aquatic activity-specific demographics, history of skin cancer followed by screening.

Results

A total of 171 surfers (n = 116) and swimmers (n = 55) participated in the study. Both groups were identified as having a history of skin cancer (surfers 41.4%, swimmers 36.4%) and a family history of skin cancer (surfers 52.6%, swimmers 43.6%). The majority of both groups reported using a high percentage of a chemical or physical skin cancer prevention strategy (surfers 100%, Swimmers 92.7%, P = 0.003). Significantly more surfers were identified with a skin cancer of any type vs. swimmers (50% vs. 27.3%; OR 2.67; P = 0.005) with most the common skin cancer being PSC (44.7% vs. 11.3%, P = 0.076) followed by basal cell carcinoma (BCC) (24.2% vs. 7.6%, P = 0.068). There was a total of seven MSC identified in surfers and swimmers (4.6% vs. 0.8%, respectively, P = 0.137). Most skin cancers in surfers were located on the face (28.0%) followed by the arm and back (12.1% each), whereas in swimmers, the majority of skin cancers were identified on the face (17.3%), followed by the arm and lower leg (15.4% each). The highest number of melanomas were identified in surfers (n = 6) and mainly located on the face (n = 2) and back (n = 2). There was a single melanoma identified on the back in a swimmer. With the groups combined, the majority (42.9%) of melanomas were identified on the back in participants, followed by the face (28.6%). Rates per 100,000 of NMSC and MSC in surfers and swimmers (respectively) were BCC (11,206 vs. 14,545), squamous cell carcinoma (SCC) in situ (13,793 vs. 12,727), SCC (1,724 vs. 3,636) and MSC (5,172 vs. 1,818). When compared to the general Australian population, surfers and swimmers had higher odds ratios (OR), which included BCCs (OR 7.3 and 9.4, respectively), SCCs (OR 1.7 and 3.5, respectively) and MSC (OR 96.7 and 18.8, respectively).

Conclusion

Surfers and swimmers had consistently higher rates of PSC, NMSC and MSC than the general Australian population. Point prevalence of MSC (groups combined) was 76-fold higher than the general Australian population. These findings highlight the clinical importance of regular skin cancer screenings in individuals who surf or swim for early detection and treatment of skin cancer. Additionally, these aquatic enthusiasts should be advised of the benefits of sun protection strategies such as chemical and physical barriers to reduce the likelihood of developing skin cancer.

Photoprotection in Outdoor Sports: A Review of the Literature and Recommendations to Reduce Risk Among Athletes

Solar exposure, for long hours and often at peak times with limited shade available, predisposes athletes to episodic sunburn and chronic damage, causing increased risk of precancerous lesions and skin cancer. Environmental factors and training intensity affect risk. Clothing provides good protection, but changing established "uniforms" may not be possible for reasons of practicality, safety, or simply custom. Although physical activity should be encouraged for its physical and mental benefits, risk of skin damage should be minimised. We review existing behaviours, skin cancer risk, and campaigns in the sporting population and highlight key recommendations to help sun protection practices become engrained in sports practice.

Surfing on the world stage: a narrative review of acute and overuse injuries and preventative measures for the competitive and recreational surfer

Surfing has rapidly grown in popularity as the sport made its debut at the Tokyo 2020 Olympic Games. Surfing injuries are becoming more relevant with the globalisation and increasing risks of the sport, but despite this, little is known about surfing injuries or prevention strategies in either the competitive or recreational surfer. Prior research demonstrates that surfers are injured at a frequency of 0.74-1.79 injuries per 1000 hours of surfing. We reviewed the literature for the incidence, anatomical distribution, type and underlying mechanism of acute and overuse injuries, and discuss current preventative measures. This review finds that skin injuries represent the highest proportion of total injuries. Acute injuries most frequently affect the head, neck and face, followed by the lower limbs. Being struck by one's own board is the most common mechanism of injury. Non-contact acute ligament injuries have increased as surfing manoeuvres have become more acrobatic and overuse musculoskeletal injuries are highly correlated with paddling. However, there is a paucity of research for surfing injuries, and studies on overuse musculoskeletal injuries and prevention are disproportionally under-represented. Most of the prior studies are limited by small sample sizes, poor data collection methodology and geographical constraints. Further research is needed to establish preventative measures for both acute and overuse surfing injuries and to ensure the increasing popularity of surfing is met with an improved understanding of sport risks and safety. Specifically, we recommend research be prioritised regarding the efficacy of training programmes to prevent surfing-related overuse musculoskeletal injuries.

Skin cancer and sun protective behaviours in water-based sports: A scoping review

BACKGROUND

Individuals who participate in outdoor sports are subject to an increased risk of developing skin cancer. To date, there has been no review examining skin cancer and sun protective behaviours specific to outdoor, water-based sports. Therefore, this scoping reviews objectives were to (a) summarize volume and type of the scientific literature available relating to skin cancer, (b) examine current sun protective behaviours and (c) identify knowledge gaps to inform future research.

METHOD

A scoping review was conducted to address the objectives following the PRISMA guidelines. Seven databases were searched; identified studies were screened based on title, abstract and full text for outdoor water-based sports, which examined skin cancer and/or sun protective behaviours. Data were extracted, synthesized and critically appraised using a modified AXIS tool. Percentage frequencies were calculated, and key results were placed in tabular or graphical presentation.

RESULTS

Nine cross-sectional studies were identified, all defined as low-level evidence. A combined sample of 4377 participants across six countries and five water-based sports showed BCC (71%) was the most common skin cancer, followed by melanoma (18%) and SCC (10%). The head (41%) and upper limbs (27%) were the most common location.

CONCLUSION

This review highlights the minimal research available and demonstrates those in water-based sports are at high risk of developing skin cancer. Due to difficulty adhering to sun protective behaviours, the most prevalent location is the upper body. Included studies were of low-level evidence, providing opportunity for future research to expand upon the gaps in the current literature.

Sun-related behaviors, attitudes and knowledge among paralympic sailors

BACKGROUND

Overexposure to sunlight is the main cause of skin cancer. Outdoor sports increased sun exposure times. Sun protection behaviors and attitudes are utmost importance to reduce sun exposure.

AIMS

To evaluate sun exposure habits, sun protection practices, and sun-related attitudes and knowledge among paralympic sailors.

METHODS

This descriptive observational study analysed the answers of a validated self-reported questionnaire of habits, attitudes and knowledge related to sun exposure and skin cancer completed by 56 elite sailors with disabilities from 19 countries which taking part in 2019 Para World Sailing Championships.

RESULTS

Three in four (76.8%) participants reported a history of sunburn in the previous season. Overall, participants showed an average for sport practice per week of 8.0 h (SD: 4.9). Participants reported a low adherence to sun protection practice, with the exception of using sunglasses (85.7%), sunscreen (83.9%) and hat (75%), having a very low rate (28.6%) of avoidance of midday sun and an inadequate sunscreen reapplication (33.9% reported "do not reapply" and 16.1% "reapply every one or 2 h"). Although 82.1% of participants reported to be worried about can get skin cancer out of the sun, they also presented excessive sun tanning attitudes (42.9% likes sunbathing and 57.1% sunbathing makes them feel well). The average score for sun-related knowledge was low (62.1 out 100 points; SD: 13.6).

CONCLUSIONS

Awareness campaigns on sun risk are needed specifically directed at this target group, in order to improve their sun protection habits and reduce the rates of sunburn associated with sports practice.

Solar Ultraviolet Exposure in Individuals Who Perform Outdoor Sport Activities

BACKGROUND

Skin cancer is the most common cancer in the USA. Therefore, it is important to review the contribution of ultraviolet radiation (UVR) exposure to skin cancer in individuals with the highest risk. Documenting the relationship between outdoor sports solar ultraviolet exposure and their risk of skin cancer along with appropriate risk mitigation strategies can help inform clinicians of practical information for counseling sun protective behaviors in this population.

METHODS

We conducted a review of the current evidence using PubMed to answer the following research questions: (1) How is ultraviolet radiation measured? (2) What is the modern utility of the ultraviolet index in modifying recreational sun protection behaviors? (3) What is the risk of developing skin cancer for outdoor sport participants? (4) What is the prevalence of skin cancer in sport participants? and (5) Is the number of nevi and solar lentigines elevated in outdoor sport participants?

RESULTS

Based on the literature, individuals who practice outdoor sport-related activities receive high ultraviolet radiation exposure, have a high risk for skin cancer, have a high prevalence for pigmented lesions, and may benefit from electronic sun protection educational interventions.

CONCLUSIONS

Individuals who practice outdoor sports experience substantially higher ultraviolet radiation exposure, routinely exceed the recommended exposure limits, and are at a higher risk of developing skin cancer. Therefore, those who are frequently engaged in outdoor leisure activities should be coached about efficient sun protective practices and relevant mobile technologies that may facilitate adherence.

Ultraviolet Radiation Exposure, Risk, and Protection in Military and Outdoor Athletes

Overexposure to ultraviolet radiation (UVR) from the sun is associated with deleterious health effects including, but not limited to, increased risk of skin cancers. Military personnel and those who participate in outdoor exercise or sports represent two potential populations at elevated risk of negative health consequences of UVR exposure due to large amounts of time spent outdoors, often in harsh UVR environments. Despite exposure to high and/or frequent doses of UVR in recreational and tactical athletes, adequate sun-protection practices are often disregarded or not well understood by many within these at-risk populations, resulting in heightened risk of negative UVR effects. The focus of this review is to examine the available literature regarding UVR exposure, risk of adverse health effects of UVR exposure, and sun protection practices in outdoor exercisers, athletes, and military personnel.

The Simulated Ocular and Whole-Body Distribution of Natural Sunlight to Kiteboarders: A High-Risk Case of UVR Exposure for Athletes Utilizing Water Surfaces in Sport

Kiteboarding is an aquatic sporting discipline that has not yet been considered in the literature to date in terms of solar ultraviolet radiation (UVR) measurement. Kiteboarders need to look upward and are placed obliquely relative to the horizon when towed behind an overhead kite over a reflective water surface. This research defines the typical body surface orientation of a kiteboarder in motion through video vector analysis and demonstrates the potential risk to ocular and skin surface damage through practical measurement of solar UVR using a manikin model. Video analysis of 51 kiteboarders was made to construct skeletal wireframes showing the surface orientation of the leg, thigh, spine, humerus, lower arm and head of a typical kiteboarder. Solar UVR dosimeter measurements made using a manikin model demonstrate that the vertex and anterior surfaces of the knee, lower leg and lower humerus received 89%, 90%, 80% and 63% of the available ambient UVR, respectively, for a typical kiteboarder who is tilted back more than 15° from vertical while in motion. Ocular (periorbital) exposures ranged from 56% to 68% of ambient. These new findings show that the anterior skin surfaces of kiteboarders and the eye are at elevated risk of solar UVR damage.

Biologically effective solar ultraviolet exposures and the potential skin cancer risk for individual gold medalists of the 2020 Tokyo Summer Olympic Games

Personal solar ultraviolet radiation exposure models were developed for 144 Olympic events scheduled outdoors from across the 33 sport disciplines that will compete in Tokyo between 24 July and 9 August 2020. Ambient exposure models were developed from existing atmospheric parameters measured over Tokyo (35.7°N 139.7°E) and were used to weight erythemally effective solar ultraviolet exposure to gold medalists, taking into account body posture and expected protection by competitor's clothing which was assessed in comparison to respective medalists of the 2016 Rio Olympics. Individual exposure models consider the ultraviolet surface albedo (lawn, concrete, water or sand) and timing of daily events held within Olympic venues. Exposure assessments are presented, including assessments of all preliminary rounds and qualifiers. Within scheduled outdoor events, we award first place (representing the highest and most harmful UV exposure) to the women's tennis singles (1680 J/m²), second to men's golf (1530 J/m²) and third to the men's cycling road race (941 J/m²) for the highest expected erythemally effective solar ultraviolet radiation exposures of the 2020 Tokyo Games. The highest expected solar ultraviolet exposures for nations expected to win greater than three gold medals among the outdoor events were found to occur in athletes from Kenya followed closely by the United States and Hungary. Gold medalists from South Korea were found to demonstrate the highest level of sun protection due to clothing at the 2016 Rio Games, and are thus expected to receive the greatest relative reduction in erythemally effective exposure during the 2020 Tokyo Games.

The inhibitory effects of compound Muniziqi granule against B16 cells and harmine induced autophagy and apoptosis by inhibiting Akt/mTOR pathway

Background

Compound Muniziqi granule (MNZQ) is a multi-component herbal preparation and a popular traditional Uighur medicine used in China for treating endocrine disorder-induced acne, chloasma, dysmenorrhea, menopausal syndrome, and melanoma. Harmine presented in MNZQ has been confirmed potential anticancer effect on the B16 cells among others. The purpose of this study is to explore the inhibitory effects of MNZQ against B16 cells and mechanism of autophagy and apoptosis induced by harmine in B16 cells.

Methods

The cell viability was calculated by CCK8 assay. The in vitro tyrosinase activity was determined by spectrophotometry. The harmine-induced autophagy was demonstrated by electron microscopy and MDC staining. Flow cytometry was used to measure cell death and cell cycle distribution. All proteins expression was assessed by western blot.

Results

MNZQ and some herb extracts contained in preparation displayed inhibitory effects on B16 cells but without inhibition on mushroom tyrosinase compared with kojic acid. The formation of autophagosome was markedly induced by harmine with the accretion of LC3-II and the degeneration of p62 in B16 cells, which indicated that harmine was an autophagy inducer. Cell death and sub-G2 population suggested that harmine could induce cell death. Particularly, 3-MA, an autophagy inhibitor, was discovered to prevent harmine-induced decrease of the cell viability and cell cycle arrest on G2 phase, indicating that autophagy was vital to the cell death. In addition, the results indicated that harmine could inhibit the phosphorylation of Akt and mTOR, which might mediate autophagy.

Conclusion

Harmine could induce autophagy and apoptosis by inhibiting Akt/mTOR pathway in B16 cells. Harmine might be a promising therapeutic agent for treatment of melanoma in MNZQ.

Geographic region: Does it matter in cutaneous melanoma of the head and neck?

OBJECTIVES/HYPOTHESIS

The head and neck are two of the most common locations for cutaneous melanoma. We present the first population-based analysis of geographic differences in anatomic subsite, clinicopathologic and demographical traits, histopathologic subtype, treatment modality, and disease-specific survival (DSS) of cutaneous head and neck melanoma (CHNM).

STUDY DESIGN

Retrospective database analysis.

METHODS

The Surveillance, Epidemiology, and End Results database was queried for cases of CHNM reported between 2000 and 2013. Patients were grouped into East, Midwest, South, and West regions of the United States. Overall incidence, demographic traits, primary tumor site, clinicopathologic traits, histopathologic subtype, treatment modality, and DSS were compared among regions.

RESULTS

There were 49,365 patients with CHNM identified. The West (4.60) and the South (4.42) had significantly higher incidence (per 100,000) than the East (3.84) and Midwest (3.65) (P < .05). DSS was significantly different among regions (P < .0066). The East (5 years: 89.4%, 10 years: 84.1%) had the highest DSS rate, and the South (5 years: 87.0%, 10 years: 81.8%) had the lowest DSS rate. The Midwest (5 years: 88.4%, 10 years: 84.3%) and West (5 years: 88.3%, 10 years: 83.5%) had intermediate DSS. On multivariate analysis, the South had an elevated hazard ratio (1.17, 95% confidence interval: 1.05-1.30) when compared to the West.

CONCLUSIONS

Geographic region may play a significant role in CHNM. Incidence is higher in the South and the West. Incidence, histologic subtype, treatment modality, and DSS vary among regions. DSS is lower in the South than the West, even after accounting for other major prognostic factors.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:2763-2769, 2017.

Surgery combined with local 5-aminolevulinic acid-photodynamic therapy on skin cancer and its effect on the expression of cyclophilin A, cyclophilin B and CD147

The study evaluated an approach to treat skin cancer using surgery combined with local 5-aminolevulinic acid-photodynamic therapy (ALA-PDT). Seventy-six patients with skin cancer who were admitted to the Liaocheng People's Hospital from May 2014 to April 2015 were randomly divided into a control and an observation group (38 cases in each). The patients in the control group were treated with ALA-PDT alone. Those in the observation group were first subjected to surgical treatment, and then treated with ALA-PDT. The treatment efficacies of the two groups were compared. The expression of cancer markers CyPA, CyPB and CD147 were detected by immunohistochemical methods before and after the treatment. Our results showed the average healing time of the wounds of patients in the observation group was shorter, the number of treatments needed was less, the efficacy rate and the lesion appearance satisfaction were significantly higher, and the recurrence rate at 12 months after treatment and the incidence of adverse reactions were both significantly lower. Additionally, the levels of CyPA, CyPB and CD147 were reduced to a significantly higher degree after treatment in the observation group. No difference was found in the recurrence rate between the two groups at 6 months after treatment. We conclude that surgery combined with ALA-PDT is a safe and reliable treatment method, which can increase the survival rate while improving the recovery rate and appearance satisfaction in patients with skin cancer.