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Farberg AS, Heysek RV, Haber R, Agha R, Crawford KM, Xinge J, Stricker JB. Freedom from Recurrence across Age in Non-Melanoma Skin Cancer Treated with Image-Guided Superficial Radiation Therapy. Geriatrics (Basel) 2024; 9:114. [PMID: 39311239 PMCID: PMC11417751 DOI: 10.3390/geriatrics9050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 09/26/2024] Open
Abstract
Non-melanoma skin cancers (NMSCs) are a significant cause of morbidity and mortality; their incidence is increasing most in older patients. NMSCs have traditionally been treated with surgical excision, curettage, Mohs micrographic surgery (MMS), and superficial radiotherapy (SRT). Image-guided SRT (IGSRT) is a treatment option for poor surgical candidates or patients with low- or high-risk, early-stage NMSC who prefer to avoid surgery. This large retrospective cohort study compared 2-, 4-, and 6-year freedom from recurrence in biopsy-proven NMSC lesions treated with IGSRT (n = 20,069 lesions) between patients aged < 65 years (n = 3158 lesions) and ≥65 years (n = 16,911 lesions). Overall freedom from recurrence rates were 99.68% at 2 years, 99.57% at 4 years, and 99.57% at 6 years. Rates did not differ significantly by age (p = 0.8) nor by sex among the two age groups (p > 0.9). There was a significant difference in recurrence among older patients when analyzed by stage (p = 0.032), but no difference by stage in younger patients (p = 0.7). For early-stage NMSCs, IGSRT is a clinically equivalent alternative to MMS and statistically significant in superiority to non-image-guided SRT. This study demonstrates that there is no significant effect of age on 2-, 4-, or 6-year freedom from recurrence in patients with IGSRT-treated NMSC.
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Affiliation(s)
- Aaron S. Farberg
- Bare Dermatology, Dallas, TX 75235, USA;
- University of North Texas Health Science Center, University of North Texas, Fort Worth, TX 76107, USA
| | | | - Robert Haber
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
| | - Rania Agha
- Department of Dermatology, The University of Illinois at Chicago, Chicago, IL 60607, USA;
- Jesse Brown VA Medical Center, Chicago, IL 60612, USA
- Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Kevin M. Crawford
- Department of Dermatology, Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, USA
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ji Xinge
- Independent Researcher, Champaign, IL 61822, USA;
| | - Jeffrey Blake Stricker
- Dermatology Specialists of Alabama, Dothan, AL 36303, USA
- Alabama College of Osteopathic Medicine, Dothan, AL 36303, USA
- Southeast Health Internal Medicine Residency, Dothan, AL 36301, USA
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2
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Chhabra Y, Fane ME, Pramod S, Hüser L, Zabransky DJ, Wang V, Dixit A, Zhao R, Kumah E, Brezka ML, Truskowski K, Nandi A, Marino-Bravante GE, Carey AE, Gour N, Maranto DA, Rocha MR, Harper EI, Ruiz J, Lipson EJ, Jaffee EM, Bibee K, Sunshine JC, Ji H, Weeraratna AT. Sex-dependent effects in the aged melanoma tumor microenvironment influence invasion and resistance to targeted therapy. Cell 2024:S0092-8674(24)00904-8. [PMID: 39243764 DOI: 10.1016/j.cell.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/19/2024] [Accepted: 08/07/2024] [Indexed: 09/09/2024]
Abstract
There is documented sex disparity in cutaneous melanoma incidence and mortality, increasing disproportionately with age and in the male sex. However, the underlying mechanisms remain unclear. While biological sex differences and inherent immune response variability have been assessed in tumor cells, the role of the tumor-surrounding microenvironment, contextually in aging, has been overlooked. Here, we show that skin fibroblasts undergo age-mediated, sex-dependent changes in their proliferation, senescence, ROS levels, and stress response. We find that aged male fibroblasts selectively drive an invasive, therapy-resistant phenotype in melanoma cells and promote metastasis in aged male mice by increasing AXL expression. Intrinsic aging in male fibroblasts mediated by EZH2 decline increases BMP2 secretion, which in turn drives the slower-cycling, highly invasive, and therapy-resistant melanoma cell phenotype, characteristic of the aged male TME. Inhibition of BMP2 activity blocks the emergence of invasive phenotypes and sensitizes melanoma cells to BRAF/MEK inhibition.
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Affiliation(s)
- Yash Chhabra
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Cancer Signaling and Microenvironment, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
| | - Mitchell E Fane
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Cancer Signaling and Microenvironment, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Sneha Pramod
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Laura Hüser
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Daniel J Zabransky
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Vania Wang
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Agrani Dixit
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ruzhang Zhao
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Edwin Kumah
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Megan L Brezka
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Kevin Truskowski
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Cancer Signaling and Microenvironment, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Asmita Nandi
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Gloria E Marino-Bravante
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Alexis E Carey
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Naina Gour
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Devon A Maranto
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Murilo R Rocha
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Elizabeth I Harper
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Justin Ruiz
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Evan J Lipson
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Elizabeth M Jaffee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21205, USA; The Cancer Convergence Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kristin Bibee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joel C Sunshine
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ashani T Weeraratna
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21205, USA.
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3
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Shakel Z, Costa Lima SA, Reis S. Strategies to make human skin models based on cellular senescence for ageing research. Ageing Res Rev 2024; 100:102430. [PMID: 39032611 DOI: 10.1016/j.arr.2024.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
Human skin ageing is closely related to the ageing of the whole organism, and it's a continuous multisided process that is influenced not only by genetic and physiological factors but also by the cumulative impact of environmental factors. Currently, there is a scientific community need for developing skin models representing ageing processes to (i) enhance understanding on the mechanisms of ageing, (ii) discover new drugs for the treatment of age-related diseases, and (iii) develop effective dermo-cosmetics. Bioengineers worldwide are trying to reproduce skin ageing in the laboratory aiming to better comprehend and mitigate the senescence process. This review provides details on the main ageing molecular mechanisms and procedures to obtain in vitro aged skin models.
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Affiliation(s)
- Zinaida Shakel
- LAQV, REQUIMTE, Faculty of Pharmacy, University of Porto, Portugal
| | - Sofia A Costa Lima
- LAQV, REQUIMTE, ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Portugal.
| | - Salette Reis
- LAQV, REQUIMTE, Faculty of Pharmacy, University of Porto, Portugal
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Martínez Campayo N, Paradela de la Morena S, Pértega-Díaz S, Tejera Vaquerizo A, Fonseca E. Prognostic significance of sentinel lymph node biopsy in elderly with cutaneous melanoma: systematic review and meta-analysis. Int J Dermatol 2024; 63:873-880. [PMID: 38563446 DOI: 10.1111/ijd.17092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
Sentinel lymph node biopsy is the most powerful prognostic indicator to date for cutaneous melanoma. Even though elderly patients have a lower incidence of sentinel node involvement, its results are still necessary for access to adjuvant therapies. This is highly relevant considering that the Western population shows an aging trend, and the incidence of melanoma has grown exponentially over the years, making elderly patients more likely to die from melanoma than younger ones. We performed a systematic review to investigate the prognostic significance of sentinel lymph node biopsy in elderly patients with melanoma. The systematic review was conducted following the PRISMA guidelines and registered in PROSPERO. The authors searched the Cochrane Database, EMBASE, PubMed, and WOS. Eligible studies for the systematic review were clinical trials, observational population studies, clinical or hospital-based cohort studies, and case-control studies. The meta-analysis was conducted using the R software program applying the meta package. Six reports were identified to meet the inclusion criteria. All studies were retrospective, non-randomized cohorts. The results obtained in this systematic review show a statistically significant influence of sentinel lymph node biopsy on disease-specific survival (HR = 2.87; 95% CI: 1.73-4.74) but also suggest that a positive result negatively impacts disease-free survival (HR = 3.41; 95% CI: 0.96-12.11). This meta-analysis shows that a positive sentinel lymph node biopsy does not imply differences in overall survival but significantly influences disease-specific survival and suggests an unfavorable impact on disease-free survival.
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Affiliation(s)
| | | | - Sonia Pértega-Díaz
- Department of Research, University Hospital of A Coruña, A Coruña, Spain
| | | | - Eduardo Fonseca
- Department of Dermatology, University Hospital of A Coruña, A Coruña, Spain
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5
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Lee CAA, Wu S, Chow YT, Kofman E, Williams V, Riddle M, Eide C, Ebens CL, Frank MH, Tolar J, Hook KP, AlDubayan SH, Frank NY. Accelerated Aging and Microsatellite Instability in Recessive Dystrophic Epidermolysis Bullosa-Associated Cutaneous Squamous Cell Carcinoma. J Invest Dermatol 2024; 144:1534-1543.e2. [PMID: 38272206 PMCID: PMC11267985 DOI: 10.1016/j.jid.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/22/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is a severely debilitating disorder caused by pathogenic variants in COL7A1 and is characterized by extreme skin fragility, chronic inflammation, and fibrosis. A majority of patients with RDEB develop squamous cell carcinoma, a highly aggressive skin cancer with limited treatment options currently available. In this study, we utilized an approach leveraging whole-genome sequencing and RNA sequencing across 3 different tissues in a single patient with RDEB to gain insight into possible mechanisms of RDEB-associated squamous cell carcinoma progression and to identify potential therapeutic options. As a result, we identified PLK-1 as a possible candidate for targeted therapy and discovered microsatellite instability and accelerated aging as factors potentially contributing to the aggressive nature and early onset of RDEB squamous cell carcinoma. By integrating multitissue genomic and transcriptomic analyses in a single patient, we demonstrate the promise of bridging the gap between genomic research and clinical applications for developing tailored therapies for patients with rare genetic disorders such as RDEB.
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Affiliation(s)
- Catherine A A Lee
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Transplant Research Program, Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Siyuan Wu
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Transplant Research Program, Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yuen Ting Chow
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Eric Kofman
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Broad Institute, Cambridge, Massachusetts, USA
| | - Valencia Williams
- Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Megan Riddle
- Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Cindy Eide
- Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Christen L Ebens
- Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Markus H Frank
- Harvard Medical School, Boston, Massachusetts, USA; Transplant Research Program, Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA; Department of Dermatology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Jakub Tolar
- Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA; Medical School, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA; Stem Cell Institute, Medical School, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Kristen P Hook
- Department of Dermatology, Medical School, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Saud H AlDubayan
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Broad Institute, Cambridge, Massachusetts, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Natasha Y Frank
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Transplant Research Program, Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Medicine, VA Boston Healthcare System, West Roxbury, Massachusetts, USA.
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6
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Chen CC, Luo CW, Tsai SCS, Huang JY, Yang SF, Lin FCF. Synergistic Effect of Human Papillomavirus and Environmental Factors on Skin Squamous Cell Carcinoma, Basal Cell Carcinoma, and Melanoma: Insights from a Taiwanese Cohort. Cancers (Basel) 2024; 16:2284. [PMID: 38927988 PMCID: PMC11201942 DOI: 10.3390/cancers16122284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/12/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Human papillomavirus (HPV) has been implicated in various cancers, including those affecting the skin. The study assessed the long-term risk of skin cancer associated with HPV infection in Taiwan region, using data from the National Health Insurance Research Database between 2007 and 2015. Our analysis revealed a significant increase in skin cancer risk among those with HPV, particularly for squamous cell carcinoma (SCC), the subtype with the highest observed adjusted hazard ratio (aHR) = 5.97, 95% CI: 4.96-7.19). The overall aHR for HPV-related skin cancer was 5.22 (95% CI: 4.70-5.80), indicating a notably higher risk in the HPV-positive group. The risk of skin cancer was further stratified by type, with basal cell carcinoma (aHR = 4.88, 95% CI: 4.14-5.74), and melanoma (aHR = 4.36, 95% CI: 2.76-6.89) also showing significant associations with HPV. The study also highlighted regional variations, with increased risks in southern Taiwan and the Kaohsiung-Pingtung area. Key findings emphasize the importance of sun protection, particularly in regions of high UV exposure and among individuals in high-risk occupations. This research contributes to a better understanding of the complex interactions between HPV and skin cancer risk, reinforcing the importance of preventive strategies in public health.
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Affiliation(s)
- Chun-Chia Chen
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.-C.C.); (J.-Y.H.); (S.-F.Y.)
- Division of Plastic Surgery, Department of Surgery, Chi Mei Medical Center, Tainan 71004, Taiwan
| | - Ci-Wen Luo
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan;
| | - Stella Chin-Shaw Tsai
- Superintendent Office, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Shin University, Taichung 402202, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.-C.C.); (J.-Y.H.); (S.-F.Y.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.-C.C.); (J.-Y.H.); (S.-F.Y.)
| | - Frank Cheu-Feng Lin
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Mehri M, Karazhian M, Nikyar A, Mehri R, Bagheri A, Akbari M, Roshandel G, Teimoorian M. Incidence Rates and Time Trends of Skin Cancer in Golestan Province, Northeastern Iran, 2005-2018. ARCHIVES OF IRANIAN MEDICINE 2024; 27:289-297. [PMID: 38855798 PMCID: PMC11264628 DOI: 10.34172/aim.28801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/14/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Given the significant occurrence of skin cancer in the Middle East and the existing research gap concerning its incidence and trends, this research aimed to study the epidemiology and trend changes of skin cancer in the Golestan province, Northeastern Iran. METHODS The Golestan Population-based Cancer Registry's (GPCR's) data bank was utilized to gather information on confirmed skin cancer cases in the province during 2005-2018. We used Poisson regression analysis for comparing incidence rates between groups. P values less than 0.05 were considered statistically significant. RESULTS Of 1690 patients (mean age: 62.05±15.83 years), most were male (60.1%) and resided in urban areas (61.5%). The age-standardized rate (ASR) of non-melanoma and melanoma skin cancer was 8.49 and 0.56 per 100000 persons-year, respectively. A notably higher ASR for non-melanoma skin cancer (NMSC) was observed in men (ASR: 10.60; 95% CI: 9.91-11.29) (P<0.01) and urban residents (ASR: 10.19; 95% CI: 9.52-10.82) (P<0.01). There was no significant difference in the ASR of melanoma skin cancer based on gender (P=0.24) and place of residence (P=0.48). The incidence trend of melanoma (estimated annual percent change [EAPC]: -3.28; 95% CI: -18.54 to 14.83) and NMSC (EAPC: 0.39; 95% CI: -3.99 to 4.97) did not differ significantly. CONCLUSION During the 14-year study period, the ASR of both types of skin cancer exhibited a consistent pattern, except for NMSC, which showed higher rates among men and urban residents. This should be taken into consideration when formulating preventive and control strategies in the study area.
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Affiliation(s)
- Majid Mehri
- Department of Internal Medicine, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mina Karazhian
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Arash Nikyar
- Department of Research and Technology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Romina Mehri
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ali Bagheri
- Deputy of Public Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahnaz Akbari
- Deputy of Treatment, Golestan University of Medical Sciences, Gorgan, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehrdad Teimoorian
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
- Stem Cell Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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8
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Kong Y, Xing P, Huai P, Zhang F. The burden of skin diseases in China: global burden of Disease Study 2019. Arch Dermatol Res 2024; 316:277. [PMID: 38796625 DOI: 10.1007/s00403-024-03046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/07/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
Skin diseases continue to affect human health and cause a significant disease burden on the healthcare system.We aimed to report the changing trends in the burden of skin disease in China from 1990 to 2019, Which has an important role in developing targeted prevention strategies. We applied Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 analytical tools to calculate the age-standardized Prevalence and Incidence in 2019, number of years lived with disability (YLDs) and age-standardized YLDs from 1990 to 2019 of skin and subcutaneous diseases, notifiable infectious skin diseases and skin tumors in China. Among the skin and subcutaneous diseases in China in 2019, dermatitis contributed to the greatest YLD (2.17 million, 95% uncertainty interval[UI]: 1.28-3.36). Age-standardized YLD rates for leprosy decreased from 0.09 (95%UI: 0.06-0.13) in 1990 to 0.04 (95%UI: 0.03-0.06) in 2019; the proportional decrease was 55.56% over 30 years. Age-standardized YLDs for HIV and sexually transmitted infections increased by 26% during the same time period. Age-standardized YLDs for non-melanoma skin cancer increased at a much higher rate than melanoma between 1990 and 2019. Dermatitis and scabies continue to have an important role in the burden of skin and subcutaneous disease burden in China. The burden of non-melanoma cell cancer has increased most significantly over the past three decades.
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Affiliation(s)
- Yaoyao Kong
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China
| | - Peiye Xing
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China
| | - Pengcheng Huai
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China.
| | - Furen Zhang
- Hospital for Skin Diseases, Shandong First Medical University, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, No.27397 of Jingshi Road, Jinan, 250022, China
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9
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Mahmoud NM, Soliman AM. Early automated detection system for skin cancer diagnosis using artificial intelligent techniques. Sci Rep 2024; 14:9749. [PMID: 38679633 PMCID: PMC11056372 DOI: 10.1038/s41598-024-59783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
Recently, skin cancer is one of the spread and dangerous cancers around the world. Early detection of skin cancer can reduce mortality. Traditional methods for skin cancer detection are painful, time-consuming, expensive, and may cause the disease to spread out. Dermoscopy is used for noninvasive diagnosis of skin cancer. Artificial Intelligence (AI) plays a vital role in diseases' diagnosis especially in biomedical engineering field. The automated detection systems based on AI reduce the complications in the traditional methods and can improve skin cancer's diagnosis rate. In this paper, automated early detection system for skin cancer dermoscopic images using artificial intelligent is presented. Adaptive snake (AS) and region growing (RG) algorithms are used for automated segmentation and compared with each other. The results show that AS is accurate and efficient (accuracy = 96%) more than RG algorithm (accuracy = 90%). Artificial Neural networks (ANN) and support vector machine (SVM) algorithms are used for automated classification compared with each other. The proposed system with ANN algorithm shows high accuracy (94%), precision (96%), specificity (95.83%), sensitivity (recall) (92.30%), and F1-score (0.94). The proposed system is easy to use, time consuming, enables patients to make early detection for skin cancer and has high efficiency.
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Affiliation(s)
- Nourelhoda M Mahmoud
- Biomedical Engineering Department, Faculty of Engineering, Minia University, Minya, Egypt.
| | - Ahmed M Soliman
- Biomedical Engineering Department, Faculty of Engineering, Helwan University, Cairo, Egypt
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10
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Chao CH, Wu CY, Chou FL, Chen YJ. Methotrexate did not add skin cancer risk in patients with psoriasis receiving narrowband ultraviolet B phototherapy: a nationwide retrospective cohort study. Clin Exp Dermatol 2024; 49:459-465. [PMID: 38056487 DOI: 10.1093/ced/llad424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND In the era of biologic therapy, phototherapy and methotrexate (MTX) are still commonly used for treatment in patients with moderate-to-severe psoriasis. However, the skin cancer risk following a combination of MTX and narrowband ultraviolet B (NB-UVB) has rarely been explored. OBJECTIVES To investigate whether MTX plus NB-UVB increases skin cancer risk in patients with psoriasis. METHODS We conducted a retrospective cohort study of data in the Taiwan National Health Insurance Research Database from 1997 to 2013. Cumulative incidences and multivariate analysis were investigated using a competing risk regression model, comparing skin cancer risk between cohorts of people having combination therapy and those using NB-UVB alone, matched for relative confounders. We further conducted a sensitivity analysis for those receiving a higher MTX dose. Standardized incidence ratios (SIRs) were calculated for skin cancer risk. RESULTS We enrolled 3203 participants in each cohort. No significant differences in skin cancers were noted between the two cohorts for the cumulative incidences (log-rank test, P = 0.28) and for the hazard ratio (HRs) [adjusted HR 0.50, 95% confidence interval (CI) 0.15-1.63, P = 0.247] in the competing risk regression model. There were also no significant differences between those receiving higher-dose MTX and UVB alone in the cumulative incidences of skin cancers (P = 0.23) and the HR (adjusted HR = 0.29, 95% CI 0.04-2.21, P = 0.23) in the multivariate analysis. There was no significant difference in the SIR between the two cohorts compared with the general population. CONCLUSIONS In the Taiwanese population, MTX does not increase skin cancer risk in patients with moderate-to-severe psoriasis receiving NB-UVB.
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Affiliation(s)
| | - Chun-Ying Wu
- Division of Translational Research
- Institute of Biomedical Informatics and Research Center for Epidemic Prevention and
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- National Institute of Cancer Research and Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - Fan-Ling Chou
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan
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11
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Koli R, Mannur VS, Shetti PP. Robust high-performance thin-layer chromatography (HPTLC) method for stability assessment and simultaneous quantification of epigallocatechin-3-gallate and rosmarinic acid in lipid-based nanoparticles and biological matrices. PHYTOCHEMICAL ANALYSIS : PCA 2024. [PMID: 38623624 DOI: 10.1002/pca.3360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Skin cancer poses a significant health risk globally, necessitating effective and safe therapeutic interventions. Epigallocatechin-3-gallate (EGCG) from green tea and rosmarinic acid (RA) from herbs like rosemary offer promising anticancer properties. Combining these compounds may enhance their effectiveness, prompting the need for a reliable analytical method to quantify them. OBJECTIVE Herein, we present the development and validation of a high-performance thin-layer chromatography (HPTLC) method for concurrent quantification of EGCG and RA in lipid-based nanoparticles and biological samples. METHODOLOGY The method underwent optimisation through design of experiments (DoE), resulting in the establishment of robust chromatographic conditions. The separation process utilised aluminium HPTLC plates coated with silica gel 60 F254 as the stationary phase, with the mobile phase comprising ethyl acetate, toluene, formic acid, and methanol in a ratio of 4:4:1:1 v/v. RESULTS The retention factor (Rf) values obtained were 0.38 for EGCG and 0.61 for RA. The method demonstrated linearity over a range of 100-500 ng/band for both compounds with excellent correlation coefficients. Limits of detection and quantification were determined, indicating high sensitivity. Precision evaluations revealed relative standard deviation below 2%, ensuring method reproducibility. Recovery assays in lipid-based nanoparticles, plasma, and urine samples demonstrated excellent recoveries (96.2%-102.1%). Forced degradation studies revealed minimal degradation under various stress conditions, with photolytic degradation showing the least impact. CONCLUSION The developed HPTLC method offers a rapid, sensitive, and reliable approach for quantifying EGCG and RA, laying the groundwork for their further investigation as anticancer agents alone and in combination therapies.
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Affiliation(s)
- Rahul Koli
- Department of Pharmaceutical Quality Assurance, KLE College of Pharmacy, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Vinod S Mannur
- Department of Pharmaceutical Quality Assurance, KLE College of Pharmacy, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Priya P Shetti
- Dr Prabhakar Kore, Basic Science Research Centre, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
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12
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Nowakowska MK, Li Y, Mohr C, Smith B, Ferris LK, Wehner MR. Prevalence of Total Body Skin Examinations among Dermatology Encounters in Medicare Data: A Retrospective Cohort Study. J Invest Dermatol 2024; 144:905-908.e16. [PMID: 37757914 DOI: 10.1016/j.jid.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Affiliation(s)
| | - Yao Li
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cassandra Mohr
- McGovern Medical School, UTHealth Houston, Houston, Texas, USA
| | - Brandon Smith
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mackenzie R Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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13
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Pradhan R, Yu OHY, Platt RW, Azoulay L. Glucagon like peptide-1 receptor agonists and the risk of skin cancer among patients with type 2 diabetes: Population-based cohort study. Diabet Med 2024; 41:e15248. [PMID: 37876318 DOI: 10.1111/dme.15248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
AIMS The objective of this study was to determine whether the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with an increased risk of melanoma and nonmelanoma skin cancer, separately, compared with the use of sulfonylureas among patients with type 2 diabetes. METHODS Using the United Kingdom Clinical Practice Research Datalink (2007-2019), we assembled two new-user active comparator cohorts. In the first cohort assessing melanoma as the outcome, 11,786 new users of GLP-1 RAs were compared with 208,519 new users of sulfonylureas. In the second cohort assessing nonmelanoma skin cancer as the outcome, 11,774 new users of GLP-1 RAs were compared with 207,788 new users of sulfonylureas. Cox proportional hazards models weighted using propensity score fine stratification were fit to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of melanoma and nonmelanoma skin cancer, respectively. RESULTS Compared with sulfonylureas, GLP-1 RAs were not associated with an increased risk of either melanoma (42.6 vs. 43.9 per 100,000 person-years, respectively; HR 0.96, 95% CI 0.53-1.75) or nonmelanoma skin cancer (243.9 vs. 229.9 per 100,000 person-years, respectively; HR 1.03, 95% CI 0.80-1.33). There was no evidence of an association between cumulative duration of use with either melanoma or nonmelanoma skin cancer. Consistent results were observed in secondary and sensitivity analyses. CONCLUSIONS In this population-based cohort study, GLP-1 RAs were not associated with an increased risk of melanoma or nonmelanoma skin cancer, compared with sulfonylureas.
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Affiliation(s)
- Richeek Pradhan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, Quebec, Canada
| | - Oriana H Y Yu
- Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, Quebec, Canada
- Division of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, Quebec, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
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14
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Wang Z, Wang X, Shi Y, Wu S, Ding Y, Yao G, Chen J. Advancements in elucidating the pathogenesis of actinic keratosis: present state and future prospects. Front Med (Lausanne) 2024; 11:1330491. [PMID: 38566927 PMCID: PMC10985158 DOI: 10.3389/fmed.2024.1330491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Solar keratosis, also known as actinic keratosis (AK), is becoming increasingly prevalent. It is a benign tumor that develops in the epidermis. Individuals with AK typically exhibit irregular, red, scaly bumps or patches as a result of prolonged exposure to UV rays. These growths primarily appear on sun-exposed areas of the skin such as the face, scalp, and hands. Presently, dermatologists are actively studying AK due to its rising incidence rate in the United States. However, the underlying causes of AK remain poorly understood. Previous research has indicated that the onset of AK involves various mechanisms including UV ray-induced inflammation, oxidative stress, complex mutagenesis, resulting immunosuppression, inhibited apoptosis, dysregulated cell cycle, altered cell proliferation, tissue remodeling, and human papillomavirus (HPV) infection. AK can develop in three ways: spontaneous regression, persistence, or progression into invasive cutaneous squamous cell carcinoma (cSCC). Multiple risk factors and diverse signaling pathways collectively contribute to its complex pathogenesis. To mitigate the risk of cancerous changes associated with long-term UV radiation exposure, prompt identification, management, and prevention of AK are crucial. The objective of this review is to elucidate the primary mechanisms underlying AK malignancy and identify potential treatment targets for dermatologists in clinical settings.
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Affiliation(s)
- Zhongzhi Wang
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Xiaolie Wang
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yuanyang Shi
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Siyu Wu
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Yu Ding
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Guotai Yao
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianghan Chen
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai, China
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15
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Grassi D, De Monti M, Espeli V, De Pellegrin L. Use of a Dermal Regeneration Template in a two-stage reconstruction after extensive skin surgery for Bowen's disease of the anterior neck - Case report. Int J Surg Case Rep 2024; 115:109208. [PMID: 38199019 PMCID: PMC10824778 DOI: 10.1016/j.ijscr.2023.109208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Dermal Regeneration Templates may be used in the reconstruction of large skin defects after cutaneous malignancy excisions. Bowen's disease (BD; squamous cell carcinoma in situ) is a common and persistent condition that can be related to chronic sun damage, and consequently, is usually located on the head and neck area or on the lower limbs. Literature does not provide clear guidelines on the treatment of BD, limiting itself to describing a wide range of different methods that can be used, including surgery, laser therapy or topical options. However, large lesions tend to scar in the post-operative setting and hence are difficult to treat surgically. PRESENTATION OF CASE In this paper the authors present a case of a male in his 60s, ASA III score, who presented with a history of histopathologically-confirmed squamocellular carcinoma in the neck and supraclavicular region. Due to recurrent carcinomas the patient was treated with an extensive skin excision and a successful reconstruction using a Dermal Regeneration Template. The work has been reported in line with the SCARE criteria. DISCUSSION The main surgical problem caused by BD is reaching complete oncological resection and, consequently, the need for extensive skin excisions. CONCLUSION The use of the skin substitute resulted in a satisfactory functional and aesthetic result, with total clearance and no recurrence observed after 16 months.
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Affiliation(s)
- Davide Grassi
- EOC - Mendrisio Beata Vergine Regional Hospital - Department of General Surgery, Switzerland
| | - Marco De Monti
- EOC - Mendrisio Beata Vergine Regional Hospital - Department of General Surgery, Switzerland.
| | - Vittoria Espeli
- EOC - Mendrisio Beata Vergine Regional Hospital - Oncology Institute of Southern Switzerland, Switzerland
| | - Laura De Pellegrin
- EOC - Mendrisio Beata Vergine Regional Hospital - Department of General Surgery, Switzerland
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16
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Rooker A, Ouwerkerk W, Bekkenk MW, Luiten RM, Bakker WJ. The Risk of Keratinocyte Cancer in Vitiligo and the Potential Mechanisms Involved. J Invest Dermatol 2024; 144:234-242. [PMID: 37791932 DOI: 10.1016/j.jid.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 10/05/2023]
Abstract
Although light skin types are associated with increased skin cancer risk, a lower incidence of both melanoma and nonmelanoma skin cancer (NMSC) has been reported in patients with vitiligo. We performed a systematic review and meta-analysis on the NMSC risk in patients with vitiligo, indicating a reduced relative risk ratio of NMSC in vitiligo. Furthermore, we propose a series of hypotheses on the underlying mechanisms, including both immune-mediated and nonimmune-mediated pathways. This study reveals insights into the relationship between vitiligo and keratinocyte cancer and can also be used to better inform patients with vitiligo.
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Affiliation(s)
- Alex Rooker
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Wouter Ouwerkerk
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands; VU University of Amsterdam, Amsterdam, The Netherlands
| | - Rosalie M Luiten
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands.
| | - Walbert J Bakker
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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17
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Aoki KC, Glick BP, Bartos S. Complex Management of Basal Cell Carcinoma in a Frail Patient. Cureus 2024; 16:e53518. [PMID: 38440025 PMCID: PMC10911882 DOI: 10.7759/cureus.53518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Basal cell carcinoma (BCC) is one of the most common cancers diagnosed in older patients and has low mortality. Surgical versus medical management is considered in patients with multiple comorbidities and limited life expectancy (LLE), where the risk-to-benefit ratio must be carefully assessed. Watchful waiting (WW) is a viable option for some patients with severe LLE when follow-up care can be provided vigilantly and frequently. Special consideration should be given to morbidity factors such as tumor growth, bleeding, pain, and social withdrawal that negatively affect the quality of life. We present the case of a 75-year-old male with a past medical history of multiple system atrophy, who presented with a BCC on the ear and face. We discuss the management of this patient and factors that may have led to the inappropriate use of WW.
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Affiliation(s)
- Kawaiola Cael Aoki
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Brad P Glick
- Dermatology, Larkin Community Hospital Palm Springs Campus, Margate, USA
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18
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Nanz L, Keim U, Katalinic A, Meyer T, Garbe C, Leiter U. Epidemiology of Keratinocyte Skin Cancer with a Focus on Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:606. [PMID: 38339357 PMCID: PMC10854623 DOI: 10.3390/cancers16030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
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.
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Affiliation(s)
- Lena Nanz
- Center for Dermatooncology, Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; (L.N.); (U.K.); (C.G.)
| | - Ulrike Keim
- Center for Dermatooncology, Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; (L.N.); (U.K.); (C.G.)
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Maria-Göppert-Str. 22, 23562 Lübeck, Germany;
| | - Thomas Meyer
- Department of Dermatology, Venerology, and Allergology, University of Bochum, Gudrunstr. 56, 44791 Bochum, Germany;
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; (L.N.); (U.K.); (C.G.)
| | - Ulrike Leiter
- Center for Dermatooncology, Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; (L.N.); (U.K.); (C.G.)
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19
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Navsaria LJ, Li Y, Tripathy S, Mohr CA, Hinkston CL, Margolis DJ, Wehner MR. Keratinocyte Carcinoma Incidence by Race and Ethnicity in Older Adults With Medicare Coverage. JAMA Dermatol 2024; 160:109-111. [PMID: 38019561 PMCID: PMC10687708 DOI: 10.1001/jamadermatol.2023.4643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/29/2023] [Indexed: 11/30/2023]
Abstract
This cohort study examines raw and age-adjusted differences in the incidence of keratinocyte carcinoma among Medicare beneficiaries by race and ethnicity.
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Affiliation(s)
- Lucy J. Navsaria
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Yao Li
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Sanjna Tripathy
- McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Cassandra A. Mohr
- McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Candice L. Hinkston
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - David J. Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mackenzie R. Wehner
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
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20
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Nakamura A, Kataoka K, Takatsuka S, Takenouchi T. Aging trends in skin cancer: A long-term observational study in Japan. JAAD Int 2023; 13:32-34. [PMID: 37638204 PMCID: PMC10450971 DOI: 10.1016/j.jdin.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Anna Nakamura
- Division of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
- Division of Dermatology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Kazuya Kataoka
- Division of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Sumiko Takatsuka
- Division of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
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21
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Bratland Å, Munoz-Couselo E, Mortier L, Roshdy O, González R, Schachter J, Arance AM, Grange F, Meyer N, Joshi AJ, Billan S, Hughes BGM, Grob JJ, Ramakrishnan K, Ge J, Gumuscu B, Swaby RF, Gutzmer R. Health-Related Quality of Life with Pembrolizumab in Patients with Locally Advanced or Recurrent or Metastatic Cutaneous Squamous Cell Carcinoma: KEYNOTE-629. Dermatol Ther (Heidelb) 2023; 13:3165-3180. [PMID: 37943491 PMCID: PMC10689716 DOI: 10.1007/s13555-023-01059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION At first interim analysis of KEYNOTE-629, health-related quality of life (HRQoL) with pembrolizumab was stable or improved over 48 weeks in recurrent or metastatic (R/M) cutaneous squamous cell carcinoma (cSCC). HRQoL results from the second interim analysis in R/M or locally advanced (LA) cSCC are presented. METHODS Patients received pembrolizumab 200 mg every 3 weeks for ≤ 2 years. Change in EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EQ-5D-5L scores were exploratory end points. Primary analysis was performed at week 12 to ensure adequate completion/compliance. Descriptive analyses were also conducted through weeks 48 and 75 for the LA and R/M cohorts, respectively. RESULTS At data cutoff (29 July 2020), mean scores in the LA cohort (n = 47) were stable from baseline to week 12 for EORTC QLQ-C30 global health status (GHS)/quality of life (QoL) (-0.27 points [95% confidence interval (CI) -10.93 to 10.39]), physical functioning (-1.29 points [95% CI -8.77 to 6.19]), and EQ-5D-5L visual analog scale (2.06 [95% CI -7.70 to 11.82]). HRQoL remained stable through week 48 in the LA cohort; 76.6% and 74.5% of patients had improved or stable GHS/QoL and physical functioning scores, respectively. HRQoL continued to show stability or improvement through week 75 in the R/M cohort (n = 99); 71.7% and 64.6% of patients had improved or stable GHS/QoL and physical functioning scores, respectively. CONCLUSIONS Pembrolizumab has demonstrated antitumor activity and manageable safety. The current analysis shows pembrolizumab treatment preserved HRQoL. Collectively, these results support pembrolizumab as standard of care for LA or R/M cSCC. TRIAL REGISTRATION ClinicalTrials.gov, NCT03284424-September 15, 2017.
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Affiliation(s)
- Åse Bratland
- Head and Neck Oncology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Eva Munoz-Couselo
- Department of Medical Oncology, Melanoma and Other Skin Tumors Unit, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Laurent Mortier
- Department of Dermatology, INSERM U 1189, Université Lille, Centre Hospitalier Regional Universitaire de Lille, 2, Avenue Oscar Lambret, 59037, Lille, France
| | - Osama Roshdy
- Division of Dermatology, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Rene González
- Surgical Oncology, Centro Estatal de Cancerologiade Chihuahua, C. Ejercito Mexicano 3700, 31000, Chihuahua, Mexico
| | - Jacob Schachter
- Division of Oncology, Level 2, Cancer Center (Oncology Institute), Sheba Medical Center-Tel Hashomer, Emek HaEla Street 1, 52621, Ramat Gan, Israel
| | - Ana M Arance
- Medical Oncology, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Florent Grange
- Dermatology/Oncology, CHU Reims-Hôpital Robert Debre, Avenue du General Koenig Service de Dermatologie, 51100, Reims, France
- Dermatology Department, Valence Hospital, 179 Bd Maréchal Juin, 26000, Valence, France
| | - Nicolas Meyer
- Onco-Dermatology, Institut Claudius Regaud, Institut Universitaire du Cancer and CHU, 1 Avenue Irene Joliot Curie, 31059, Toulouse, France
| | - Abhishek Jagdish Joshi
- Department of Medical Oncology, Townsville University Hospital, 55 Keane Street, Douglas, QLD, 4814, Australia
| | - Salem Billan
- Head and Neck Malignancies Unit, Rambam Health Care Campus, Technion-Israel Institute of Technology, HaAliya HaShniya St 8, 52621, Haifa, Israel
| | - Brett G M Hughes
- Oncology, Clinical Research Unit, Medical Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Ground Floor, Building 34, Herston, QLD, 4029, Australia
- Department of Oncology, University of Queensland, 308 Queen St, Brisbane, QLD, 4000, Australia
| | - Jean-Jacques Grob
- Dermatology, AIX-Marseille University and APHM Hospital Marseille, 264 Rue Saint Pierre, 13385, Marseille, France
| | | | - Joy Ge
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Burak Gumuscu
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Ramona F Swaby
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Ralf Gutzmer
- Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 60325, Hannover, Germany
- Department of Dermatology, Johannes Wesling Medical Center Hans-Nolte-Straße 1, 32429, Minden, Germany
- Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
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22
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Segura S, Podlipnik S, Boada A, Martí RM, Sabat M, Yélamos O, Zarzoso-Muñoz I, Azón-Masoliver A, López-Castillo D, Solà J, Baliu-Piqué C, Galvany-Rossell L, Pasquali P, Just-Sarobé M, Duran X, Carrera C, Richarz NA, Pujol RM, Malvehy J, Puig S. Melanoma-specific survival is worse in the elderly: a multicentric cohort study. Melanoma Res 2023; 33:532-538. [PMID: 37696262 DOI: 10.1097/cmr.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
We aimed to characterise cutaneous melanoma in the elderly and determine its association with poorer prognosis. We studied a prospective cohort of the melanoma population in Catalonia between 2012 and 2016. We compared young patient group (<75 years old) with elderly patient group (≥75 years old). We included 3009 patients (52.5% women) from 14 centres, with a mean age at diagnosis of 61.1 years. In the ≥75-year-old group there was a predominance of men (53.9% vs. 45.5%, P < 0.001), melanoma was more frequently located in the head and neck area (37.7% vs. 15.5%, P < 0.001) and lentigo maligna melanoma subtype was significantly more frequent (31.4% vs. 11.6%, P < 0.001), as were nodular melanoma and acral lentiginous melanoma ( P < 0.001). In older people, Breslow index, the presence of ulceration and mitotic rate were higher than in younger people. Kaplan-Meier survival curves showed longer melanoma-specific survival (MSS) and melanoma-free survival (MFS) in <75-year-old group compared to the elderly group. Cox regression models demonstrated reduced MSS in patients ≥75 years regardless of gender, location, IB, ulceration and lymph node status at diagnosis (HR 1.54, P = 0.013) whereas MFS was not independently associated with elderly when head and neck location was considered. Age appears to be an independent risk factor for MSS but not for MFS. Worse melanoma prognosis in elderly could be explained by factors unrelated to the tumour, such as age-related frailty and comorbidities that limit the access to systemic treatments and, eventually, age-related immune dysfunction.
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Affiliation(s)
- Sonia Segura
- Dermatology Department, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona
- Universitat de Vic-Universitat Central de Catalunya (UVIC), Vic
| | - Sebastian Podlipnik
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
| | - Aram Boada
- Dermatology Department, Hospital Germans Trias i Pujol de Badalona, Badalona
| | - Rosa M Martí
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida and Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III
| | - Mireia Sabat
- Dermatology Department, Hospital Universitari Parc Taulí, Sabadell
| | - Oriol Yélamos
- Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona
| | | | | | - Daniel López-Castillo
- Dermatology Department Consorci Sanitari Integral Hospital Moises Broggi, Sant Joan Despí
| | - Joaquim Solà
- Dermatology Department, Hospital General de Granollers, Granollers
| | | | | | - Paola Pasquali
- Dermatology Department, Pius Hospital de Valls, Valls and Universidad de Alcalá, Alcalá de Henares
| | | | - Xavier Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona
| | - Cristina Carrera
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
| | - Nina A Richarz
- Dermatology Department, Hospital Germans Trias i Pujol de Badalona, Badalona
| | - Ramon M Pujol
- Dermatology Department, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
| | - Susana Puig
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
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23
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Skelin J, Tomaić V. Comparative Analysis of Alpha and Beta HPV E6 Oncoproteins: Insights into Functional Distinctions and Divergent Mechanisms of Pathogenesis. Viruses 2023; 15:2253. [PMID: 38005929 PMCID: PMC10674601 DOI: 10.3390/v15112253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Human papillomaviruses (HPVs) represent a diverse group of DNA viruses that infect epithelial cells of mucosal and cutaneous tissues, leading to a wide spectrum of clinical outcomes. Among various HPVs, alpha (α) and beta (β) types have garnered significant attention due to their associations with human health. α-HPVs are primarily linked to infections of the mucosa, with high-risk subtypes, such as HPV16 and HPV18, being the major etiological agents of cervical and oropharyngeal cancers. In contrast, β-HPVs are predominantly associated with cutaneous infections and are commonly found on healthy skin. However, certain β-types, notably HPV5 and HPV8, have been implicated in the development of non-melanoma skin cancers in immunocompromised individuals, highlighting their potential role in pathogenicity. In this review, we comprehensively analyze the similarities and differences between α- and β-HPV E6 oncoproteins, one of the major drivers of viral replication and cellular transformation, and how these impact viral fitness and the capacity to induce malignancy. In particular, we compare the mechanisms these oncoproteins use to modulate common cellular processes-apoptosis, DNA damage repair, cell differentiation, and the immune response-further shedding light on their shared and distinct features, which enable them to replicate at divergent locations of the human body and cause different types of cancer.
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Affiliation(s)
| | - Vjekoslav Tomaić
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička 54, 10000 Zagreb, Croatia;
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24
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Bowers JM, Seidenberg AB, Kemp JM. Skin Cancer Diagnosis Among People With Disabilities. Am J Prev Med 2023; 65:896-900. [PMID: 37062527 PMCID: PMC10576008 DOI: 10.1016/j.amepre.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION People with disabilities face unique challenges that may affect skin cancer prevention, diagnosis, and access to treatment. These challenges could be exacerbated by the COVID-19 pandemic. In 2022, the prevalence of self-reported skin cancer diagnoses, delayed medical care because of the coronavirus disease 2019 (COVID-19) pandemic, and skin cancer risk factors among people with disabilities were estimated. METHODS Data from the 2020 National Health Interview Survey (N=31,568 U.S. adults) were analyzed. Skin cancer diagnosis, age at the time of skin cancer diagnosis, skin cancer risk factors (e.g., sun protection), and delayed medical care because of the COVID-19 pandemic were included. Disability status was measured using the Washington Group Short Set on Functioning, which includes vision, hearing, mobility, communication, self-care, and cognitive disabilities. RESULTS Although 8.8% of U.S. adults reported having a disability, people with disabilities accounted for 14.7% of all self-reported skin cancer diagnoses, including 17.5% of melanoma diagnoses. Notably, people with disabilities were on average, older (mean age=59.8 years) than people without disabilities (mean age=46.8 years). Models that adjusted for age and other demographics revealed that people with disabilities had higher odds of delaying medical care because of the COVID-19 pandemic (OR=1.65, 95% CI=1.41, 1.94); people with disabilities reported being diagnosed with skin cancer later in life (age 61.5 vs 54.0 years; p<0.001) but had odds of reporting any skin cancer (OR=1.11, 95% CI=0.93, 1.32) or melanoma diagnosis (OR=1.33, 95% CI=0.95, 1.87) similar to those of people without disabilities. CONCLUSIONS Because of disability-related challenges, older age, and delaying medical care during the pandemic, people with disabilities may be at increased risk for inequitable skin cancer outcomes.
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Affiliation(s)
- Jennifer M Bowers
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Andrew B Seidenberg
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD; Truth Initiative Schroeder Institute, Washington, DC
| | - Jacqueline M Kemp
- Massachusetts Dermatology Associates, Beverly, MA; Department of Dermatology, Harvard Medical School, Boston, MA
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25
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Nguyen NP, Thariat J, Gorobets O, Vinh-Hung V, Kim L, Blanco SC, Vasileiou M, Arenas M, Mazibuko T, Giap H, Vincent F, Chi A, Loganadane G, Mohammadianpanah M, Rembielak A, Karlsson U, Ali A, Bose S, Page BR. Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2023; 15:4981. [PMID: 37894347 PMCID: PMC10605563 DOI: 10.3390/cancers15204981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, 14000 Cain, France;
| | - Olena Gorobets
- Department of Oral Surgery, University of Martinique, 97213 Martinique, France;
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Institut Bergonie, 33076 Bordeaux, France;
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA;
| | - Sergio Calleja Blanco
- Department of Oral and Maxillofacial Surgery, Howard University, Washington, DC 20059, USA;
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira, I Virgili, 43204 Tarragona, Spain;
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System, Lawrenceburg, TN 29425, USA;
| | - Alexander Chi
- Department of Radiation Oncology, Xuanwu Hospital, Capital Medical University, Beijing 101125, China;
| | | | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
| | - Agata Rembielak
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
- Division of Cancer Sciences, Faculty of Biomedicine and Health, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Ahmed Ali
- Division of Hematology Oncology, Howard University, Washington, DC 20059, USA;
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore 21218, MD, USA;
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26
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Reichert C, Baldini C, Mezghani S, Maubec E, Longvert C, Mortier L, Quereux G, Jannic A, Machet L, de Quatrebarbes J, Nardin C, Beneton N, Amini Adle M, Funck-Brentano E, Descamps V, Hachon L, Malissen N, Baroudjian B, Brunet-Possenti F. Combined Nivolumab and Ipilimumab in Octogenarian and Nonagenarian Melanoma Patients. Cancers (Basel) 2023; 15:4330. [PMID: 37686606 PMCID: PMC10486537 DOI: 10.3390/cancers15174330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Data regarding elderly melanoma patients treated with anti-PD-1 or anti-CTLA-4 antibodies are in favor of tolerability outcomes that are similar to those of younger counterparts. However, there are very few studies focusing on elderly patients receiving nivolumab combined with ipilimumab (NIVO + IPI). Here, we ask what are the current prescribing patterns of NIVO + IPI in the very elderly population and analyze the tolerance profile. This French multicenter retrospective study was conducted on 60 melanoma patients aged 80 years and older treated with NIVO + IPI between January 2011 and June 2022. The mean age at first NIVO + IPI administration was 83.7 years (range: 79.3-93.3 years). Fifty-five patients (92%) were in good general condition and lived at home. Two dosing regimens were used: NIVO 1 mg/kg + IPI 3 mg/kg Q3W (NIVO1 + IPI3) in 27 patients (45%) and NIVO 3 mg/kg + IPI 1 mg/kg Q3W (NIVO3 + IPI1) in 33 patients (55%). NIVO + IPI was a first-line treatment in 39 patients (65%). The global prevalence of immune-related adverse events was 63% (38/60), with 27% (16/60) being of grade 3 or higher. Grade ≥ 3 adverse events were less frequent in patients treated with NIVO3 + IPI1 compared with those treated with NIVO1 + IPI3 (12% versus 44%, p = 0.04). In conclusion, the prescribing patterns of NIVO + IPI in very elderly patients are heterogeneous in terms of the dosing regimen and line of treatment. The safety profile of NIVO + IPI is reassuring; whether or not the low-dose regimen NIVO3 + IPI1 should be preferred over NIVO1 + IPI3 in patients aged 80 years or older remains an open question.
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Affiliation(s)
- Constance Reichert
- Department of Dermatology, Hôpital Bichat AP-HP, Université Paris Cité, 75018 Paris, France; (C.R.); (V.D.)
| | - Capucine Baldini
- Drug Development Department, Institut Gustave Roussy, CNRS-UMS 3655 and INSERM US23, 94805 Villejuif, France;
| | - Sarah Mezghani
- Department of Imaging, Institut Curie, PSL Research University, 75005 Paris, France;
| | - Eve Maubec
- Department of Dermatology, Hôpital Avicenne AP-HP, Université Sorbonne Paris Nord—Campus de Bobigny, 93000 Bobigny, France;
| | - Christine Longvert
- Department of Dermatology, EA4340-BECCOH, Hôpital Ambroise Paré APHP, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.L.); (E.F.-B.)
| | - Laurent Mortier
- Department of Dermatology, Claude Huriez Hospital, Lille University, Inserm U1189, 59000 Lille, France;
| | - Gaëlle Quereux
- Department of Dermatology, Centre Hospitalier Universitaire de Nantes, CIC 1413, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes University, 44000 Nantes, France;
| | - Arnaud Jannic
- Dermatology Department, Hôpital Henri Mondor AP-HP, 94000 Créteil, France;
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, 37000 Tours, France;
| | - Julie de Quatrebarbes
- Department of Dermatology, Centre Hospitalier Annecy-Genevois, 74370 Annecy, France;
| | - Charlée Nardin
- Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, 25000 Besançon, France;
| | - Nathalie Beneton
- Department of Dermatology, Centre Hospitalier du Mans, 72037 Le Mans, France;
| | - Mona Amini Adle
- Oncodermatology Department Centre Léon Bérard, 69008 Lyon, France;
| | - Elisa Funck-Brentano
- Department of Dermatology, EA4340-BECCOH, Hôpital Ambroise Paré APHP, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.L.); (E.F.-B.)
| | - Vincent Descamps
- Department of Dermatology, Hôpital Bichat AP-HP, Université Paris Cité, 75018 Paris, France; (C.R.); (V.D.)
| | - Lorry Hachon
- Department of Pharmacy, Hôpital Bichat, AP-HP, 75018 Paris, France;
| | - Nausicaa Malissen
- Dermatology and Skin Cancer Department, APHM, CRCM Inserm U1068, CNRS U7258, CHU Timone, Aix Marseille University, 13007 Marseille, France;
| | - Barouyr Baroudjian
- Department of Dermato-Oncology, Hôpital Saint-Louis AP-HP, Inserm U976, Université Paris Cité, 75010 Paris, France;
| | - Florence Brunet-Possenti
- Department of Dermatology, Hôpital Bichat AP-HP, Université Paris Cité, 75018 Paris, France; (C.R.); (V.D.)
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27
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Chicheł A, Chyrek AJ, Kluska A, Burchardt WM. Advanced non-melanoma skin cancer in elderly patients: When surgery says NO, interventional radiotherapy (brachytherapy) says YES. J Contemp Brachytherapy 2023; 15:235-244. [PMID: 37799126 PMCID: PMC10548428 DOI: 10.5114/jcb.2023.130715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/29/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose The prevalence of non-melanoma skin cancer (NMSC) increases, especially in older adults with comorbidities, narrowing radical treatment options. About 5% of skin cancer patients are diagnosed with an advanced stage, which impairs daily functioning. The study was to present a retrospective summary of elderly patients unfit for surgery and treated with various brachytherapy (BT) techniques tailored individually for locally advanced NMSCs in a reference BT department. Clinical case presentations supported the findings. Material and methods Inoperable patients older than 75 years presenting with advanced pathologically confirmed NMSCs were retrospectively identified. All cases were individually assessed, and the best suiting radical treatment option was chosen, including contact, interstitial, or hybrid high-dose-rate (HDR) or pulsed-dose-rate (PDR) BT. Doses ranging from 45 to 60 Gy were administered to clinical target volume (CTV) in different time schedules. All patients were closely followed-up until complete remission. Results Ten elderly patients (mean age, 84 years) with differently located locally advanced NMSCs (all staged T3) were treated between 2007 and 2022. Six basal and four squamous cell carcinoma cases showed most painful symptoms as well as bleeding and exudation. Six patients underwent HDR-BT and four PDR-BT. Six patients had superficial, and four interstitial or hybrid applications. All patients completed the intended protocols. Median follow-up was 8.5 months (range, 3-35 months). Six out of ten patients died from other reasons before analysis. All case data were presented in the text and respective figures. Conclusions Advanced NMSCs in elderly patients are challenging in terms of cure. Inoperable cases may be referred for feasible and locally effective interventional radiotherapy (BT). Individually tailored BT leads to an excellent disease control, function sparing, symptoms release, and quality of life improvement. Large treated volumes are related to prolonged healing. BT should be discussed in a multidisciplinary tumor board regarding older patients with symptomatic functions affecting advanced NMSCs.
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Affiliation(s)
- Adam Chicheł
- Department of Brachytherapy, Greater Poland Cancer Center, Poznan’, Poland
| | - Artur J. Chyrek
- Department of Brachytherapy, Greater Poland Cancer Center, Poznan’, Poland
| | - Adam Kluska
- Department of Brachytherapy, Greater Poland Cancer Center, Poznan’, Poland
| | - Wojciech M. Burchardt
- Department of Brachytherapy, Greater Poland Cancer Center, Poznan’, Poland
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan’, Poland
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28
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Song X, Chen CI, Konidaris G, Zimmerman NM, Ruiz E. Real-world analysis of cost, treatment patterns, and outcomes of patients with metastatic cutaneous squamous cell carcinoma in the US. Expert Rev Pharmacoecon Outcomes Res 2023; 23:911-920. [PMID: 37313647 DOI: 10.1080/14737167.2023.2223982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To describe real-world characteristics and treatment patterns of patients with metastatic cutaneous squamous cell carcinoma (mCSCC). METHODS This retrospective observational study used MarketScan Commercial and Medicare Supplemental claims databases (1/1/2013-7/31/2019). Adult patients with mCSCC who initiated non-immunotherapy systemic treatment (i.e. index event) between 1 January 2014 and 31 December 2018 were assessed for treatment patterns, all-cause and CSCC-related healthcare resource utilization, costs, and mortality . RESULTS Overall, 207 patients were included in the study(mean age 64.8 years, 76.3% male), 59.4% had prior radiotherapy, and 58.9% had prior CSCC-related surgery. During follow-up, 75.8%, 51.7%, and 35.7% of patients received chemotherapy, radiotherapy, and targeted therapy as first-line treatment, respectively. Cisplatin (32.9%) and carboplatin (22.7%) were the most common chemotherapy agents, and cetuximab (32.4%) was the most common targeted therapy during the first-line.Probability of death (95% CI) at month 6, year 1, and year 2 was 24% (16-32%), 50% (40 - 59%), and 67% (56 - 75%), respectively. Average CSCC-related healthcare costs were $5,354 per person per month (PPPM), with outpatient costs being the major cost driver at 96.4% ($5,160 PPPM). CONCLUSION During 2014-2018, patients with mCSCC were commonly treated with cisplatin and cetuximab; prognosis was generally poor. These results indicate opportunity for new treatments to improve survival outcomes.
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Affiliation(s)
- Xue Song
- Regeneron Pharmaceuticals, Inc, Sleepy Hollow, NY, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc, Sleepy Hollow, NY, USA
| | | | | | - Emily Ruiz
- Department of Dermatology, Dana-Farber Cancer Institute, Boston, MA, USA
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29
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Crisan D, Kastler S, Scharffetter-Kochanek K, Crisan M, Schneider LA. Ultrasonographic Assessment of Depth Infiltration in Melanoma and Non-melanoma Skin Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1609-1616. [PMID: 36714967 DOI: 10.1002/jum.16180] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/26/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
The preoperative assessment of infiltration depth in melanoma and non-melanoma skin cancer by means of high-frequency ultrasound (≥18 MhZ) is essential for optimizing the therapeutic approach in our patients. Often, histologically confirmed skin tumors are directly referred to surgical departments for resection, and sonography is increasingly helping us identify those subjects who are no longer candidates for extensive surgical interventions. In cases of deep tumor infiltration, with potential surgical failure e.g. impairment of the quality of life and significant esthetic and functional complications, preoperative sonography can guide the surgeon to withstand from an operation and decide instead in favor of less mutilating radiooncological or medical treatment options. Furthermore, in melanoma patients, the preoperative knowledge of the tumor depth is essential for the determination of the therapeutic approach, the correct safety margins and the need of a sentinelnode biopsy. We herein encourage the use of preoperative sonography in dermatologic surgery whenever possible as it represents an easy, painless, "in vivo" method, which provides clinicians with significant clinical information that can influence the therapy and improve patient compliance.
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Affiliation(s)
- Diana Crisan
- Clinic of Dermatology and Allergology, University Clinic Ulm, Ulm, Germany
| | - Sabine Kastler
- Clinic of Dermatology and Allergology, University Clinic Ulm, Ulm, Germany
| | | | - Maria Crisan
- Clinic of Dermatology and Venerology, Cluj-Napoca County Hospital, Cluj-Napoca, Romania
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30
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Zwart AT, Kok LMC, de Vries J, van Kester MS, Dierckx RAJO, de Bock GH, van der Hoorn A, Halmos GB. Radiologically Defined Sarcopenia as a Biomarker for Frailty and Malnutrition in Head and Neck Skin Cancer Patients. J Clin Med 2023; 12:jcm12103445. [PMID: 37240550 DOI: 10.3390/jcm12103445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to evaluate whether radiologically defined sarcopenia, or a low skeletal muscle index (SMI), could be used as a practical biomarker for frailty and postoperative complications (POC) in patients with head and neck skin cancer (HNSC). This was a retrospective study on prospectively collected data. The L3 SMI (cm2/m2) was calculated with use of baseline CT or MRI neck scans and low SMIs were defined using sex-specific cut-off values. A geriatric assessment with a broad range of validated tools was performed at baseline. POC was graded with the Clavien-Dindo Classification (with a grade of > II as the cut-off). Univariate and multivariable regression analyses were performed with low SMIs and POC as the endpoints. The patients' (n = 57) mean age was 77.0 ± 9 years, 68.4% were male, and 50.9% had stage III-IV cancer. Frailty was determined according to Geriatric 8 (G8) score (OR 7.68, 95% CI 1.19-49.66, p = 0.032) and the risk of malnutrition was determined according to the Malnutrition Universal Screening Tool (OR 9.55, 95% CI 1.19-76.94, p = 0.034), and these were independently related to low SMIs. Frailty based on G8 score (OR 5.42, 95% CI 1.25-23.49, p = 0.024) was the only variable related to POC. However, POC was more prevalent in patients with low SMIs (∆ 19%, OR 1.8, 95% CI 0.5-6.0, p = 0.356).To conclude, a low SMI is a practical biomarker for frailty and malnutrition in HNSC. Future research should be focused on interventions based on low SMI scores and assess the effect of the intervention on SMI, frailty, malnutrition, and POC.
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Affiliation(s)
- Aniek T Zwart
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Laurence M C Kok
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Julius de Vries
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Marloes S van Kester
- Department of Dermatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Dermatology, Haga Hospital Location Leyweg (Hagaziekenhuis), 2545 AA The Hague, The Netherlands
| | - Rudi A J O Dierckx
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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Spanos S, Singh N, Laginha BI, Arnolda G, Wilkinson D, Smith AL, Cust AE, Braithwaite J, Rapport F. Measuring the quality of skin cancer management in primary care: A scoping review. Australas J Dermatol 2023; 64:177-193. [PMID: 36960976 PMCID: PMC10952799 DOI: 10.1111/ajd.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Bela I. Laginha
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - David Wilkinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
- National Skin Cancer CentresSouth BrisbaneQueenslandAustralia
| | - Andrea L. Smith
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Anne E. Cust
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
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Rembielak A, Yau T, Akagunduz B, Aspeslagh S, Colloca G, Conway A, Danwata F, Del Marmol V, O'Shea C, Verhaert M, Zic R, Livesey D. Recommendations of the International Society of Geriatric Oncology on skin cancer management in older patients. J Geriatr Oncol 2023; 14:101502. [PMID: 37080793 DOI: 10.1016/j.jgo.2023.101502] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Non-melanoma skin cancer (NMSC) is becoming ever more prevalent among older adults. However, older adults with NMSC are often underrepresented in clinical trials and guidelines on effective management is still unclear. The International Society of Geriatric Oncology (SIOG) created a multi-disciplinary task force to explore the potential in developing practical guidelines for the treatment of older patients with basal cell carcinoma (BCC) and skin (cutaneous) squamous cell carcinoma (cSCC). MATERIALS AND METHODS A systematic literature search to identify relevant and up-to-date literature on treatment of NMSC in older adults was conducted on various databases including MEDLINE, Embase, CINAHL, Cochrane, and PubMed. The resulting papers were discussed by an expert panel, leading to a consensus recommendation. RESULTS A total of 154 articles were identified for the expert panel to utilise in generating consensus recommendations. A major focus on geriatric assessment and management options including surgery, radiotherapy, systemic therapy, clinical monitoring, and medical/medicophysical therapy were reviewed for recommendations. DISCUSSION Patient age should not be the sole deciding factor in the management of patients with NMSC. Assessment from a multidisciplinary team (MDT) is crucial, and the decision-making process should consider the patient's lifestyle, needs, and expectations. A comprehensive geriatric assessment should also be considered. Patients should feel empowered to advocate for themselves and have their views considered a part of the MDT discussion.
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Affiliation(s)
- Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Thomas Yau
- Barts and the London School of Medicine and Dentistry, Young SIOG Member, Queen Mary University of London, London, UK.
| | - Baran Akagunduz
- Young SIOG Member, Department of Medical Oncology, Erzincan Binali Yıldrıım University Medical School, Erzincan, Turkey
| | - Sandrine Aspeslagh
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Belgium.
| | - Giuseppe Colloca
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Aoife Conway
- Department of Radiation Oncology, The Mater Hospital, Crows Nest, NSW, Australia.
| | - Falalu Danwata
- Rosemere Cancer Centre, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.
| | - Veronique Del Marmol
- Department of Dermatology and Venereology, Hopital Erasme-Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Marthe Verhaert
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Belgium.
| | - Rado Zic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, Zagreb, Croatia.
| | - Dan Livesey
- The Christie Library, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK.
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Zemtsov A, Cognetta A, Marvel J, Logan A. Proposed guidelines for appropriate utilization of superficial radiation therapy in management of skin cancers. Zemtsov-Cognetta criteria. Skin Res Technol 2023; 29:e13311. [PMID: 37113089 PMCID: PMC10234161 DOI: 10.1111/srt.13311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To develop appropriate use criteria (AUC) for the treatment of basal cell and squamous cell carcinoma by superficial radiation therapy (SRT) technique. MATERIAL AND METHODS Delphi-type discussion of the experts. RESULTS Presented in Figure 1. CONCLUSION These AUCs are in compliance both with the position statement of the American Academy of Dermatology (AAD) and the ASTRO Clinical Practice Guideline on this subject. It is further recommended that SRT will be only performed by either a dermatologist who is board certified in Mohs surgery (MDS) and who had adequate SRT training or by radiation oncologists. Hopefully, this publication will stimulate further discussion on this topic.
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Affiliation(s)
- Alexander Zemtsov
- University Dermatology CenterMuncieIndianaUSA
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Armand Cognetta
- Florida State University School of MedicineTallahasseeFloridaUSA
| | - John Marvel
- University Dermatology CenterMuncieIndianaUSA
- Cancer Care GroupIndianapolisIndianaUSA
| | - Ann Logan
- University Dermatology CenterMuncieIndianaUSA
- Cancer Care GroupIndianapolisIndianaUSA
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Correya T, Duncan Z, Garcia N, Amu-Nnadi C, Broman K. Incidence and Risk Factors for Incidental Cancer on Melanoma Wide Excisions. J Surg Res 2023; 284:24-28. [PMID: 36527767 PMCID: PMC9911357 DOI: 10.1016/j.jss.2022.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cancer patients and survivors have a high risk of developing additional malignancies. Patients who undergo melanoma excision often have sun-damaged skin and are predisposed to concurrent and subsequent skin cancers. The unexpected finding of an incidental cancer on melanoma wide excisions can require further surgery and delays adjuvant treatment. We aimed to determine the incidence and risk factors for incidental skin cancers in patients who had surgical excision of melanoma. METHODS Our single-center retrospective study analyzed all patients diagnosed with primary melanoma at our institution from July 1, 2019 through June 30, 2020. We included patients with localized cutaneous melanoma who underwent surgical excision and had relevant pathology data available. Descriptive statistics and univariate analyses were performed on the demographic, clinical, and pathological data collected. We analyzed differences between the groups with and without incidental cancer to ascertain risk factors using chi-squared tests and Wilcoxon rank sum tests. Dunn's tests with Bonferroni correction were performed for multiple pairwise comparisons. RESULTS There were 642 patients who met the criteria for inclusion, of whom 13 (2.0%) had incidental cancers identified on a pathologic assessment. Six (46%) had incidental squamous cell carcinoma and seven (54%) had basal cell carcinoma. With regard to management of incidental cancer, three (23%) patients required additional surgery for margin re-excision. Risk factors for incidental cancers in melanoma excision included older age (median 79 versus 62 y, P < 0.001), male sex (P = 0.042), and primary tumor location in the head/neck region relative to trunk (P < 0.01) or extremity (P < 0.01) primary sites. CONCLUSIONS Although the frequency of incidental findings on melanoma excision is low, certain patients are at a greater risk including older male individuals with head/neck melanomas. These findings can be used to improve preoperative counseling of at-risk patients when melanoma excision is planned.
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Affiliation(s)
- Tanya Correya
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
| | - Zoey Duncan
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Natalie Garcia
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Kristy Broman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
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Borg T, Eisold J, Miyanjo Y, Pappa E. The effect of COVID‐19 on surgical management of skin cancers of the head, face and neck in elderly patients. SKIN HEALTH AND DISEASE 2023; 3:e175. [PMID: 37025367 PMCID: PMC10071305 DOI: 10.1002/ski2.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 03/30/2023]
Abstract
Background The Corona Virus (COVID-19) has had a profound impact on healthcare systems worldwide, with interruptions to medical practices including the delivery of cancer treatment. Skin cancer is one of the leading causes of malignancy worldwide, with later stages of disease correlating to poorer prognosis. Immunocompromized and elderly patients represent populations that are at higher risk for adverse outcomes related to skin cancer, treatment delay and COVID-19 infection. Methodology Patients aged 65 and above who underwent surgical management of skin cancers from 31 January 2020 to 31 January 2021 were included in this study then compared with samples pre- and post-pandemic. Retrospective analysis was performed regarding: date of referral to date of surgery, skin cancer type, location of cancer, surgery performed, anaesthesia used, sutures used and outcomes. Data was compared to national guidelines. Results Five hundred and twenty skin cancers were included in this analysis, of which 340 were treated during the COVID-19 pandemic. Of the cohort treated during the pandemic, 44.2% (n = 111) received excision and direct closure, 13.1% (n = 33) underwent reconstruction by integra dermal substitute, 3.2% (n = 8) by split thickness skin graft, 6.4% (n = 16) by full thickness skin grafts and 33.1% (n = 83) by local flaps. Complete excision was achieved in 88.5% of cases (n = 301). The mean time from referral to surgery was 119 days. There were no deaths associated with COVID-19. Conclusion Safe and prompt treatment of head and neck skin cancers is achievable despite the COVID-19 pandemic. Measures to minimize infection risk include the use of teledermatology, reliable COVID-19 testing, Green Pathways and a reduction in the mean referral to surgery time.
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Affiliation(s)
| | | | - Yusuf Miyanjo
- Department of Oral and Maxillofacial SurgeryQueen's HospitalLondonUK
| | - Elena Pappa
- Department of Oral and Maxillofacial SurgeryQueen's HospitalLondonUK
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Huang J, Zhang L, Shi L, Wu M, Lv T, Zhang Y, Lai Y, Tu Q, Wang X, Wang H. An epidemiological study on skin tumors of the elderly in a community in Shanghai, China. Sci Rep 2023; 13:4441. [PMID: 36932111 PMCID: PMC10023674 DOI: 10.1038/s41598-023-29012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/30/2023] [Indexed: 03/19/2023] Open
Abstract
The morbidity of skin tumors (ST) in China is a great concern as the population ages. No epidemiological survey on ST in elderly communities in China has been reported. A questionnaire survey was conducted among the residents over 60 years old in a community in Shanghai, China from May 1, 2011 to November 30, 2011. The prevalence of cutaneous tumors and associated factors were analyzed. Among 2038 valid cases, a total of 78 (3.8%, 95% CI 3.0-4.7) skin cancers (SC) were confirmed. According to the final multivariate regression analysis, age, gender and previous occupation were the significantly influential factors for SC. Actinic keratosis (AK) accounted for the largest proportion (63, 3.1%) in SC. The head and neck was the physiological site with the highest incidence of SC (64, 82.1%), and AK was the most common (55, 87.3%) in head and neck SC. The common concomitant diseases of SC were hypertension (26, 33.3%) and diabetes mellitus (9, 11.5%). Seborrheic keratosis (SK) was the most common benign skin tumor with a prevalence of 100%. Men and women developed SK in significantly different parts of the body (P < 0.0001). The incidence of ST in the elderly population in Shanghai community increased with age. ST preferred to occur in the head and neck, which might be attributed to excessive ultraviolet (UV) exposure in these areas. Therefore, early diagnosis and sun-protection education are essential interventions for ST in the elderly.
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Affiliation(s)
- Jianhua Huang
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Shi
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Minfeng Wu
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Ting Lv
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yongxian Lai
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingfeng Tu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Hongwei Wang
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China.
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Unar A, Khan H, Zahid N, Khan MA, Fatima S, Shaikh SA, Rahman MF. Association of the Depth of Invasion With Recurrence Rates of Basal Cell Carcinoma in a Tertiary Health Care Facility: A Retrospective Study Over a Period of Six Years. Cureus 2023; 15:e36276. [PMID: 37073206 PMCID: PMC10105902 DOI: 10.7759/cureus.36276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/19/2023] Open
Abstract
Background Basal cell carcinoma (BCC) is one of the most common types of cutaneous malignancies and the most frequently occurring form of cancer worldwide. The incidence of basal cell carcinoma is difficult to determine due to its wide geographic variations; however, it has been increasing worldwide with an annual increase of 7% in the number of reported cases. Although BCC is more prevalent in the aging population, diagnosis in younger individuals is steadily increasing. BCC has overall low mortality, however, it leads to significant economic and physical impact on patients and their families along with adding burden to the healthcare system. The primary risk factor for the development of BCC is increased cumulative sun exposure, particularly to UV radiation. The UV index of Karachi averages around 12 (extremely high) during summer months, putting the population at a significantly higher risk of developing BCC in the long term. Objectives This audit was undertaken with the following primary objectives: to use the data collected to determine possible prognostic factors for BCC, to measure the rate of recurrence and the number of new primary tumors detected, to study the completeness of follow-up by patients, and to co-relate histopathological findings with the recurrence rate of basal cell carcinoma. Methods A retrospective analysis was performed for all patients with BCC who had undergone surgical resection over a six-year time period. Patient charts were reviewed for demographic information, tumor size, onset-to-diagnosis, anatomic location, clinical subtype, histologic differentiation, method of surgical treatment, and recurrence. Data were entered and analyzed in SPSS version 23 (IBM Corp., Armonk, NY). Results The review identified cases of BCC in 99 patients. Of the 99 patients, 60.39% were men and 38.38% were women. The most frequent age group was 65-85-year-olds (42 patients, 42.85%) for BCC. Based on the aesthetic units of the face, the most common location was the nasal unit (30 cases, 30.30%) for BCC. Most of the lesions were closed primarily; however; local flaps were used in the case of surgical defects. The recurrence rate was 19.19% for BCC in this study. Our study included 1.0% of patients who were classified as Clark classification level 2 of BCC, 6.1% as Clark level 3, 23.4% as Clark level 4, and 0.16% as Clark level 5. Recurrence rates were seen to increase with increasing Clark classification level in this study. Conclusion In our study, many characteristics of BCC were compared to previously published reports and the results were seen to be generally similar. This study correlates the recurrence of BCC with Clark's classification, showing that depth of invasion is a significant factor in predicting recurrence. There is a paucity of literature regarding the depth of invasion of BCC along with its' Clarks classification and recurrence. Further studies can help explore and establish the characteristics of BCC.
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Martineau J, Walz SN, Scampa M, Giordano S, Kalbermatten DF, Oranges CM. Spiradenocarcinoma: SEER Study of Epidemiology, Survival, and Treatment Options. J Clin Med 2023; 12:jcm12052045. [PMID: 36902832 PMCID: PMC10004548 DOI: 10.3390/jcm12052045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
(1) Background: Spiradenocarcinoma is an extremely rare malignant adnexal tumor and there are only few studies on survival outcomes. Our aim was to perform an analysis of the demographic and pathological characteristics, treatment patterns, and survival outcomes of patients affected by spiradenocarcinoma. (2) Methods: The Surveillance, Epidemiology, and End Results program database of the National Cancer Institute was searched for all cases of spiradenocarcinoma diagnosed between 2000 and 2019. This database is considered representative of the US population. Demographic, pathological, and treatment variables were retrieved. Overall and disease-specific survival were computed according to the different variables. (3) Results: 90 cases of spiradenocarcinoma (47 females, 43 males) were identified. Mean age at diagnosis was 62.8 years. Regional and distant disease at diagnosis were rare, occurring in 2.2% and 3.3% of cases, respectively. Surgery alone was the most frequent treatment (87.8%), followed by a combination of surgery and radiotherapy (3.3%) and radiation therapy only (1.1%). Five-year overall survival was 76.2% and five-year disease-specific survival was 95.7%. (4) Conclusions: Spiradenocarcinoma equally affects males and females. Regional and distant invasion rates are low. Disease-specific mortality is low and is probably overestimated in the literature. Surgical excision remains the main form of treatment.
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Affiliation(s)
- Jérôme Martineau
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Solange N. Walz
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Matteo Scampa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Salvatore Giordano
- Department of General and Plastic Surgery, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Daniel F. Kalbermatten
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Carlo M. Oranges
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-(0)223-727-997
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Jung J, Waller JL, Tran S, Baer SL, Kheda M, Mohammed A, Padala S, Young L, Siddiqui B, Bollag WB. Cutaneous squamous cell carcinoma and mortality in end-stage renal disease. Am J Med Sci 2023; 365:249-257. [PMID: 36403674 DOI: 10.1016/j.amjms.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the general population, cutaneous squamous cell carcinoma (cSCC) is associated with increased all-cause mortality. Transplant patients have been shown to have an increased risk of developing cSCC, and their cSCC is associated with an increased risk for mortality. In end-stage renal disease (ESRD) patients, there is extensive mortality and immune dysfunction. Because of this immune system dysfunction, we examined whether cSCC is associated with increased risk of all-cause mortality among ESRD patients, as well as the risk factors for cSCC. METHODS We analyzed ESRD patients in the United States Renal Data System from 2004-2014, excluding organ transplant recipients. We assessed mortality using a Cox Proportional Hazards (CPH) model to control for various demographic and clinical parameters, identified using international classification of diseases (ICD)-9 codes. RESULTS Of the 1,035,193 patients included, 624 (0.1%) were diagnosed with cSCC. The median survival time for those with cSCC was 3.91 years [95% confidence interval (CI) = 3.67-4.15], versus 2.92 years [95%CI = 2.92-2.93] for patients without cSCC. ESRD patients with cSCC were at lower risk of death [adjusted hazard ratio = 0.75; 95%CI = 0.69-0.82] compared to those without. Decreased risk of death was also associated with parameters such as black race, Hispanic ethnicity, tobacco dependence and actinic keratosis. Increased mortality risk was associated with increasing age, male sex, hemodialysis (versus peritoneal dialysis) and alcohol dependence. CONCLUSIONS Contrary to expectations, ESRD patients with a cSCC diagnosis showed reduced all-cause mortality risk relative to those without. The reason for this discrepancy remains unclear, suggesting the need for further study.
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Affiliation(s)
- Joo Jung
- Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Jennifer L Waller
- Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Sarah Tran
- Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Stephanie L Baer
- Medical College of Georgia at Augusta University, Augusta, GA, United States; Charlie Norwood VA Medical Center, Augusta, GA, United States
| | - Mufaddal Kheda
- Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Azeem Mohammed
- Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Sandeep Padala
- Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Lufei Young
- College of Nursing at Augusta University, Augusta, GA, United States
| | - Budder Siddiqui
- Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Wendy B Bollag
- Medical College of Georgia at Augusta University, Augusta, GA, United States; Charlie Norwood VA Medical Center, Augusta, GA, United States.
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Van Coile L, Verhaeghe E, Ongenae K, Destrooper L, Mohamadi Z, Brochez L, Hoorens I. The therapeutic dilemma of basal cell carcinoma in older adults: A review of the current literature. J Geriatr Oncol 2023; 14:101475. [PMID: 36990928 DOI: 10.1016/j.jgo.2023.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/26/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Abstract
Skin cancer is known to be a significant health care threat due to the massively increasing numbers of diagnoses. In 2019, 4 million basal cell carcinoma (BCC) cases were diagnosed globally, making BCC the most frequent of all cancers worldwide in fair skinned populations. Given the increasing life-expectancy for all countries worldwide (by 2050, the world's population of people aged 60 years and older will have doubled), the incidence of BCC is expected to keep increasing in the future. Management of BCCs is challenging, especially among older adults, as mortality due to BCCs is extremely rare, whereas locally destructive growth can cause significant morbidity in certain cases. Therapeutic management in this population is further hampered because of the presence of comorbidities, frailty, and the heterogeneity of these aspects in older patients, leading to treatment dilemmas. A literature review was conducted to identify relevant patient, tumour, and treatment related factors that should be considered in the decision making for BCC treatment in older adults. This narrative review synthesizes all aspects concerning BCC treatment in older adults and aims to make some specific suggestions considering BCC treatment in older adults that can be used in daily practice. We found that nodular BCC was found to be the most common subtype in older adults, most frequently located in the head and neck region. In non-facial BCCs, current literature has shown no significant impact on the quality of life (QoL) in older patients. Besides comorbidity scores, functional status should guide clinicians in treatment decisions. Taking all aspects into account when making treatment decisions is of great importance. When treating superficial BCCs on difficult-to-reach lesions in older adults, a clinician-administered treatment should be suggested because of possible impaired mobility in these patients. Based on current literature, we recommend assessing the comorbidities, the functional status, and frailty in older patients with BCC to evaluate life expectancy. In patients with low-risk BCCs and a limited life expectancy (LLE), an active surveillance or watchful waiting strategy can be suggested.
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Yang DD, Borsky K, Jani C, Crowley C, Rodrigues JN, Matin RN, Marshall DC, Salciccioli JD, Shalhoub J, Goodall R. Trends in keratinocyte skin cancer incidence, mortality and burden of disease in 33 countries between 1990 and 2017. Br J Dermatol 2023; 188:237-246. [PMID: 36763862 DOI: 10.1093/bjd/ljac064] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/02/2022] [Accepted: 10/18/2022] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
| | - Kim Borsky
- Medical Data Research Collaborative, London, UK
| | - Chinmay Jani
- Medical Data Research Collaborative, London, UK.,Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Conor Crowley
- Medical Data Research Collaborative, London, UK.,Division of Pulmonary and Critical Care Medicine, Lahey Hospital, Burlington, MA, USA
| | | | - Rubeta N Matin
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dominic C Marshall
- Medical Data Research Collaborative, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Justin D Salciccioli
- Medical Data Research Collaborative, London, UK.,Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph Shalhoub
- Medical Data Research Collaborative, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Goodall
- Medical Data Research Collaborative, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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42
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The Role of Machine Learning and Deep Learning Approaches for the Detection of Skin Cancer. Healthcare (Basel) 2023; 11:healthcare11030415. [PMID: 36766989 PMCID: PMC9914395 DOI: 10.3390/healthcare11030415] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Machine learning (ML) can enhance a dermatologist's work, from diagnosis to customized care. The development of ML algorithms in dermatology has been supported lately regarding links to digital data processing (e.g., electronic medical records, Image Archives, omics), quicker computing and cheaper data storage. This article describes the fundamentals of ML-based implementations, as well as future limits and concerns for the production of skin cancer detection and classification systems. We also explored five fields of dermatology using deep learning applications: (1) the classification of diseases by clinical photos, (2) der moto pathology visual classification of cancer, and (3) the measurement of skin diseases by smartphone applications and personal tracking systems. This analysis aims to provide dermatologists with a guide that helps demystify the basics of ML and its different applications to identify their possible challenges correctly. This paper surveyed studies on skin cancer detection using deep learning to assess the features and advantages of other techniques. Moreover, this paper also defined the basic requirements for creating a skin cancer detection application, which revolves around two main issues: the full segmentation image and the tracking of the lesion on the skin using deep learning. Most of the techniques found in this survey address these two problems. Some of the methods also categorize the type of cancer too.
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43
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Yamakawa S, Suda S, Hayashida K. A new lower eyelid reconstruction using transverse facial artery perforator flap based on an anatomical study. J Plast Reconstr Aesthet Surg 2023; 77:39-45. [PMID: 36563637 DOI: 10.1016/j.bjps.2022.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/17/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
With the ageing of the global society, the demand for lower eyelid reconstruction following malignant skin tumour resection is increasing. For decades, flaps that require excessive dissection have been used to reconstruct relatively large lower eyelid defects. A new, less invasive option is needed for elderly patients. We present a new surgical technique using a transverse facial artery perforator flap. Records of 11 patients who underwent lower eyelid reconstruction with transverse facial artery perforator flaps after malignant skin tumour resection were reviewed. The mean age of the patients was 85.7 ± 6.7 years. Six patients underwent surgery under local anaesthesia and five under general anaesthesia. Malignant skin tumours were resected with 4-10 mm of the surrounding skin, depending on the tumour type. An ipsilateral transverse facial artery perforator flap was raised to cover the defect. Primary reconstructions were achieved in all cases. The median follow-up period was 13 (range, 9-33) months. Two minor complications occurred during the follow-up period: pyogenic granuloma (n = 1) and temporary ocular pain and conjunctivitis (n = 1). The incidence of complications and the results of the functional and aesthetic evaluation based on the modified patient-reported outcome measure showed no significant differences between the two different anaesthesia groups. To the best of our knowledge, this is the first report to describe the use of a transverse facial artery perforator flap for lower eyelid reconstruction. The flap may be an effective option for lower eyelid reconstruction in elderly patients to achieve good functional and aesthetic outcomes with low risk and minimal invasion.
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Affiliation(s)
- Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine Shimane University, 89-1 Enya-cho Izumo Shimane 693-8501, Shimane, Japan.
| | - Shota Suda
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine Shimane University, 89-1 Enya-cho Izumo Shimane 693-8501, Shimane, Japan
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine Shimane University, 89-1 Enya-cho Izumo Shimane 693-8501, Shimane, Japan
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44
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Lu L, Wan B, Zeng H, Guo J, Li M, Sun M. Body mass index and the risk of basal cell carcinoma: evidence from Mendelian randomization analysis. PeerJ 2023; 11:e14781. [PMID: 36710862 PMCID: PMC9881466 DOI: 10.7717/peerj.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
Objective We aim to test whether body mass index (BMI) is causally associated with the risk of basal cell carcinoma (BCC) using Mendelian randomization (MR) analysis. Methods Single-nucleotide polymorphisms (SNPs) associated with four BMI-related traits were screened via a genome-wide association study (GWAS) with 681,275, 336,107, 454,884, and 461,460 European-descent individuals, respectively. Summary-level data for BCC (17,416 cases and 375,455 controls) were extracted from UK Biobank. An inverse variance weighted (IVW) method was employed as the primary MR analysis. Sensitivity analyses were conducted via MR-Egger regression, heterogeneity test, pleiotropy test, and leave-one-out sensitivity test. The assumption that exposure causes outcome was verified using the MR Steiger test. Meta-analysis was also used to estimate the average genetically predicted effect of BMI on BCC. Results Two-sample MR analysis showed inverse associations between genetically predicted BMI and BCC risk. Moreover, when exposure and outcome were switched to see if reverse causation was possible, there was no evidence of a cause-and-effect relationship from BCC to BMI. Finally, the meta-analysis also showed a strong negative causal relationship between BMI and BCC. Conclusion Genetical predicted higher BMI were associated with lower BCC risk. Further research is required to comprehend the mechanisms underlying this putative causative association.
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Affiliation(s)
- Likui Lu
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bangbei Wan
- Reproductive Medical Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan, China
| | - Hongtao Zeng
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jun Guo
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Min Li
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Miao Sun
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
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45
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Leahy M, Griffin L, Harrington R, Laing ME. Poor availability in Ireland of hats meeting sun-protective standards. Clin Exp Dermatol 2023; 48:32-34. [PMID: 36669174 DOI: 10.1093/ced/llac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023]
Abstract
Hats aid in reducing exposure to both direct and diffuse ultraviolet light, but hats are of mixed styles and the resultant sun-protection value is variable. Adult male patients have higher rates of skin cancer, especially of the head and neck, than other subgroups. The UK and Australia have set standards for what constitutes a sunhat, whereas no such standard exists in Ireland. We explored adult male sunhats for sale during the summer in a single urban region in the west of Ireland. All the hats available were compared with the UK standard, BS 8466:2006. Almost 90% of the hats available did not meet this standard and thus did not offer adequate sun protection. Ireland requires legislation on what constitutes a sun-hat and more availability and visibility of such hats for men to encourage the use of hats for photoprotection.
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Affiliation(s)
- Marion Leahy
- Department of Dermatology, University Hospital Galway, Galway, Ireland
| | - Laoise Griffin
- Department of Dermatology, University Hospital Galway, Galway, Ireland
| | - Robert Harrington
- Department of Dermatology, University Hospital Galway, Galway, Ireland
| | - Mary E Laing
- Department of Dermatology, University Hospital Galway, Galway, Ireland
- Dermatology Department, National University of Ireland Galway, Galway city, Ireland
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Lütgerath C, Weiß C, Böer‐Auer A. Klinisch‐pathologische Merkmale und histologische Tumorreste in Reexzisionspräparaten unvollständig resezierter Basalzellkarzinome. J Dtsch Dermatol Ges 2022; 20:1476-1484. [DOI: 10.1111/ddg.14884_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Christel Weiß
- Medizinische Statistik Biomathematik und Informationsverarbeitung Universitätsmedizin Mannheim
| | - Almut Böer‐Auer
- Dermatologikum Hamburg GmbH Hamburg
- Klinik für Hautkrankheiten Universitätsklinikum Münster
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Two Distinct Nutritional Assessment Tools Have Dissimilar Outcomes in a Sample of Older Adult Patients With Cancer. FORUM OF CLINICAL ONCOLOGY 2022. [DOI: 10.2478/fco-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction
Malnutrition is strongly associated with negative outcomes in aged populations with cancer. Several studies have compared the outcomes of nutritional-screening tools, but knowledge specifically covering older adult patients with cancer remains limited. The aim of this study was to compare the outcomes of two tools, the Patient-Generated Subjective Global Assessment (PG-SGA) versus the Mini Nutritional Assessment (MNA) for this population.
Method
Cross-sectional study with 432 participants who consented to participate and were enrolled at admission to medical and surgical wards of a tertiary referral hospital. The participants’ nutritional statuses were simultaneously assessed using the PG-SGA and the MNA, and the outcomes compared using the kappa statistical test. The Receiver Operating Characteristic Curve (ROC) was employed to calculate the MNA sensitivity, specificity, positive and negative predictive values, and was compared with PG-SGA.
Results
Prevalence of good nourishment was observed in 62.5% and 61.1% of the participants, as detected by PG-SGA and MNA, respectively. Both tools concurred moderately (kappa = 0.453). Importantly, there were significant differences in the diagnosis of malnutrition (7.6% vs. 4.6%, p = 0.000). The MNA showed sensitivity of 72.2% and specificity of 75.9% in detecting good nourishment for the population investigated.
Conclusion
The MNA may not present greater sensitivity, possibly due to a lack of coverage of gastrointestinal symptoms. It is a quick and efficient tool for nutritional assessment of older adult patients with cancer, but as it is more specific than sensitive, caution is recommended when identifying borderline or early malnourished individuals of this population.
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48
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Lütgerath C, Weiß C, Böer‐Auer A. Clinicopathological features and histological tumor residues in re‐excision specimens of incompletely resected basal cell carcinomas. J Dtsch Dermatol Ges 2022; 20:1476-1483. [DOI: 10.1111/ddg.14884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics University Medical Centre Mannheim Germany
| | - Almut Böer‐Auer
- Dermatologikum Hamburg GmbH Hamburg Germany
- Department of Dermatology University Medical Centre Münster Germany
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49
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Hu W, Fang L, Ni R, Zhang H, Pan G. Changing trends in the disease burden of non-melanoma skin cancer globally from 1990 to 2019 and its predicted level in 25 years. BMC Cancer 2022; 22:836. [PMID: 35907848 PMCID: PMC9339183 DOI: 10.1186/s12885-022-09940-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background The disease burden of non-melanoma skin cancer (NMSC) has become a significant public health threat. We aimed to conduct a comprehensive analysis to mitigate the health hazards of NMSC. Methods This study had three objectives. First, we reported the NMSC-related disease burden globally and for different subgroups (sex, socio-demographic index (SDI), etiology, and countries) in 2019. Second, we examined the temporal trend of the disease burden from 1990 to 2019. Finally, we used the Bayesian age-period-cohort (BAPC) model integrated nested Laplacian approximation to predict the disease burden in the coming 25 years. The Norpred age-period-cohort (APC) model and the Autoregressive Integrated Moving Average (ARIMA) model were used for sensitivity analysis. Results The disease burden was significantly higher in males than in females in 2019. The results showed significant differences in disease burden in different SDI regions. The better the socio-economic development, the heavier the disease burden of NMSC. The number of new cases and the ASIR of basal cell carcinoma (BCC) were higher than that of squamous cell carcinoma (SCC) in 2019 globally. However, the number of DALYs and the age-standardized DALYs rate were the opposite. There were statistically significant differences among different countries. The age-standardized incidence rate (ASIR) of NMSC increased from 54.08/100,000 (95% uncertainty interval (UI): 46.97, 62.08) in 1990 to 79.10/100,000 (95% UI: 72.29, 86.63) in 2019, with an estimated annual percentage change (EAPC) of 1.78. Other indicators (the number of new cases, the number of deaths, the number of disability-adjusted life years (DALYs), the age-standardized mortality rate (ASMR), and the age-standardized DALYs rate) showed the same trend. Our predictions suggested that the number of new cases, deaths, and DALYs attributable to NMSC would increase by at least 1.5 times from 2020 to 2044. Conclusions The disease burden attributable to NMSC will continue to increase or remain stable at high levels. Therefore, relevant policies should be developed to manage NMSC, and measures should be taken to target risk factors and high-risk groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09940-3.
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Affiliation(s)
- Wan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Lanlan Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ruyu Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hengchuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Guixia Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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50
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Tran M, Yoon S, Teoh M, Andersen S, Lam PY, Purdue BW, Raghubar A, Hanson SJ, Devitt K, Jones K, Walters S, Monkman J, Kulasinghe A, Tuong ZK, Soyer HP, Frazer IH, Nguyen Q. A robust experimental and computational analysis framework at multiple resolutions, modalities and coverages. Front Immunol 2022; 13:911873. [PMID: 35967449 PMCID: PMC9373800 DOI: 10.3389/fimmu.2022.911873] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
The ability to study cancer-immune cell communication across the whole tumor section without tissue dissociation is needed, especially for cancer immunotherapy development, which requires understanding of molecular mechanisms and discovery of more druggable targets. In this work, we assembled and evaluated an integrated experimental framework and analytical process to enable genome-wide scale discovery of ligand-receptors potentially used for cellular crosstalks, followed by targeted validation. We assessed the complementarity of four different technologies: single-cell RNA sequencing and Spatial transcriptomic (measuring over >20,000 genes), RNA In Situ Hybridization (RNAscope, measuring 4-12 genes) and Opal Polaris multiplex protein staining (4-9 proteins). To utilize the multimodal data, we implemented existing methods and also developed STRISH (Spatial TRanscriptomic In Situ Hybridization), a computational method that can automatically scan across the whole tissue section for local expression of gene (e.g. RNAscope data) and/or protein markers (e.g. Polaris data) to recapitulate an interaction landscape across the whole tissue. We evaluated the approach to discover and validate cell-cell interaction in situ through in-depth analysis of two types of cancer, basal cell carcinoma and squamous cell carcinoma, which account for over 70% of cancer cases. We showed that inference of cell-cell interactions using scRNA-seq data can misdetect or detect false positive interactions. Spatial transcriptomics still suffers from misdetecting lowly expressed ligand-receptor interactions, but reduces false discovery. RNAscope and Polaris are sensitive methods for defining the location of potential ligand receptor interactions, and the STRISH program can determine the probability that local gene co-expression reflects true cell-cell interaction. We expect that the approach described here will be widely applied to discover and validate ligand receptor interaction in different types of solid cancer tumors.
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Affiliation(s)
- M. Tran
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - S. Yoon
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
| | - M. Teoh
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - S. Andersen
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience (IMB) Sequencing Facility, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - PY. Lam
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - B. W. Purdue
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
| | - A. Raghubar
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - SJ. Hanson
- School of Medical Science, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - K. Devitt
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - K. Jones
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - S. Walters
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - J. Monkman
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - A. Kulasinghe
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - ZK. Tuong
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Medical Research Council (MRC)-Laboratory of Molecular Biology, Brisbane, United Kingdom
- Cellular Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - HP. Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Center, The University of Queensland, Brisbane, QLD, Australia
| | - I. H. Frazer
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Q. Nguyen
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Q. Nguyen,
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