The relationship between occupational sun exposure and non-melanoma skin cancer: clinical basics, epidemiology, occupational disease evaluation, and prevention

Influence of environmental risk factors on the development of wounds associated with squamous cell carcinoma

The incidence of squamous cell carcinoma (SCC) is on the rise, making it a significant global health concern. Environmental risk factors are crucial to the development of SCC. This study sought to examine comprehensively the impact of these factors on the onset of SCC. We conducted a cross-sectional study involving 480 participants at Beijing tertiary care hospital. Utilizing structured questionnaires, data on demographics, environmental exposures, medical history and clinical characteristics were collected. The cohort was composed of 272 men (56.67%) and 208 women (43.33%). The majority (44.38%) were between ages of 41 and 60, and Type III skin predominated (34.79%). Most of the participants belonged to the middle socioeconomic class (60.83%). 'Vegetarian' dietary habits (46.67%) were prevalent, as was the 'Sedentary' lifestyle (49.79%). Regarding environmental exposures, moderate sun exposure of 3 to 5 h per day (54.58%) and UV protective eyewear (30.83%) were prevalent. The majority (69.58%) of respondents indicated 'Never' exposure to carcinogens. A variety of wound characteristics were observed, with 'non-smokers' (64.17%) dominating. Most SCC lesions were located on the extremities (40.21%), lasted less than 6 months (44.38%) and measured 1-3 cm (39.79%). The majority (54.58%) did not have a history of cutaneous injuries. Our research uncovered substantial relationships between SCC and numerous environmental variables, gender, Fitzpatrick skin type, occupation, duration of sun exposure, exposure to carcinogens, dietary practices, history of skin wounds, wound location, duration, size and depth were significantly associated with the onset of SCC. These results highlighted the complexity of SCC aetiology and need for individualized prevention and treatment strategies.

Cancer patterns in Iran: a gender-specific spatial modelling of cancer incidence during 2014-2017

BACKGROUND

Cancer is a significant public health concern and the second leading cause of death. This study aims to visualize spatial patterns of top common cancer types and identify high-risk and low-risk counties for these cancers in Iran from 2014 to 2017.

METHODS

In this study, we analyzed 482,229 newly diagnosed cancer cases recorded by the Iranian National Population-Based Cancer Registry from 2014 to 2017. We employed a purely spatial scanning model and local Moran I analysis to explore spatial patterns across Iran.

RESULTS

Approximately 53% of all cases were male. The average age of cancer diagnosis was 62.58 ± 17.42 years for males and 56.11 ± 17.33years for females. Stomach cancer was the most common cancer in men. The northern and northwestern regions of Iran were identified as high-risk areas for stomach cancer in both genders, with a relative risk (RR) ranging from 1.26 to 2.64 in males and 1.19 to 3.32 in females. These areas recognized as high-risk areas for trachea, bronchus, and lung (TBL) cancer specifically in males (RR:1.15-2.02). Central regions of Iran were identified as high-risk areas for non-melanoma skin cancers in both genders, ranking as the second most common cancer (RR:1.18-5.93 in males and 1.24-5.38 in females). Furthermore, bladder cancer in males (RR:1.32-2.77) and thyroid cancer in females (RR:1.88-3.10) showed concentration in the central part of Iran. Breast cancer, being the most common cancer among women (RR:1.23-5.54), exhibited concentration in the northern regions of the country. Also, northern regions of Iran were identified as high-risk clusters for colon cancer (RR:1.31-3.31 in males and 1.33-4.13 in females), and prostate cancer in males (RR:1.22-2.31). Brain, nervous system cancer, ranked sixth among women (RR:1.26-5.25) in central areas.

CONCLUSIONS

The study's revelations on the spatial patterns of common cancer incidence in Iran provide crucial insights into the distribution and trends of these diseases. The identification of high-risk areas equips policymakers with valuable information to tailor targeted screening programs, facilitating early diagnosis and effective disease control strategies.

Far infrared light irradiation enhances Aβ clearance via increased exocytotic microglial ATP and ameliorates cognitive deficit in Alzheimer's disease-like mice

Background

Exposure to sunlight may decrease the risk of developing Alzheimer’s disease (AD), and visible and near infrared light have been proposed as a possible therapeutic strategy for AD. Here, we investigated the effects of the visible, near infrared and far infrared (FIR) light on the cognitive ability of AD mice, and found that FIR light also showed potential in the improvement of cognitive dysfunction in AD. However, the related mechanism remains to be elucidated.

Methods

Morris water maze was used to evaluate the cognitive ability of APPswe/PSEN1dE9 double-transgenic AD mice after light treatment. Western blot was carried out to detect the expression of protein involved in synaptic function and amyloid-β (Aβ) production. The protein amount of interleukin (IL)-1β, IL-6, Aβ_1-40 and Aβ_1-42 were determined using enzyme-linked immunosorbent assay. The mRNA level of receptors was performed using real-time quantitative polymerase chain reaction. Immunostaining was performed to characterize the Aβ burden and microglial Aβ phagocytosis in the brain of AD mice. The Aβ phagocytosis of primary cultured microglia and BV2 were assessed by flow cytometry. The energy metabolism changes were evaluated using related assay kits, including adenosine triphosphate (ATP), lactate content, mitochondrial respiratory chain complex enzymatic activity and oxidized/reduced nicotinamide adenine dinucleotide assay kits.

Results

Our results showed that FIR light reduced Aβ burden, a hallmark of AD neuropathology, alleviated neuroinflammation, restored the expression of the presynaptic protein synaptophysin, and ameliorated learning and memory impairment in the AD mice. FIR light enhanced mitochondrial oxidative phosphorylation pathway to increase ATP production. This increased intracellular ATP promoted the extracellular ATP release from microglia stimulated by Aβ, leading to the enhanced Aβ phagocytosis through phosphoinositide 3-kinase/mammalian target of rapamycin pathways for Aβ clearance.

Conclusions

Our findings have uncovered a previously unappreciated function of FIR light in inducing microglial phagocytosis to clean Aβ, which may be the mechanisms for FIR light to improve cognitive dysfunction in AD mice. These results suggest that FIR light treatment is a potential therapeutic strategy for AD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12974-022-02521-y.

Skin cancers and their risk factors in older persons: a population-based study

Background

The number of skin cancer is increasing rapidly. However, little is known about the risk factors of skin cancer in older persons. Our objectives were to determine the risk factors for skin cancer or its precursors in an older population. More specifically, to study the association of new skin cancers with previous skin cancer, sex, age, Fitzpatrick’s skin type, history of outdoor work and socioeconomic status (SES).

Methods

In this retrospective cross-sectional study of a large, well documented historical cohort data set a total body skin examination (TBSE) was performed for 552 participants aged between 70 and 93 years by dermatologists. The information gathered was augmented with health register data and self-reported data. The associations between skin cancer and its risk factors were studied by using the logistic regression analyses.

Results

According to the TBSE skin cancer/precursor was present in 25.5% of participants and was more common in males than in females (34.5% vs 20.2%, p < 0.001). Previous skin cancer increased the risk of subsequent skin cancer 2.6-fold (OR 2.56, 95% CI 1.43-4.55) and male sex nearly 2-fold (1.97, 95% CI 1.26-3.08). Specific risk factors for the first occurrence of skin cancer were male sex and outdoor work. There was also association between skin cancer and age and socioeconomic status.

Conclusions

TBSE is recommend for physicians treating older persons to allow early recognition of skin cancers or their precursors. Older males need particularly close attention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02964-1.

Spatial epidemiology of skin cancer in Iran: separating sun-exposed and non-sun-exposed parts of the body

Background

Skin cancer is among the most common cancer types with an increasing global trend of incidence rate. This study explores the spatial distribution of skin cancer, considering body sites exposed and not exposed to sunshine separately.

Methods

We used 4302 skin cancer cases recorded by Fars Cancer Registry in south-western Iran for over 6 years (2011–2017). The variables included in the study were patients’ residence address, gender, age, report date, and final topographical code. The patients’ addresses were geocoded to the counties of the study area. Skin cancer sites were categorized based on sun exposure in male and female cases. We used the empirical Bayesian smoothing approach to smooth the skin cancer incidence rate at the county level to remove any potential population size bias. Finally, Anselin’s Local Moran’s Index and Getis Ord G* were used to identify the clustered and high-risk skin cancer geographical areas.

Results

The incidence rates had an increasing trend from 14.28 per 100,000 people in 2011 to 17.87 per 100,000 people in 2016, however, it was decreased to 13.05 per 100,000 people in 2017. Out of 4302 patients with skin cancer, 2602 cases (60%) were male. The cancer cumulative incidence rate in males and females who were not exposed to sunshine was 7.80 and 14.18 per 100,000, respectively. The rates increased to 86.22 and 48.20 in males and females who were exposed to the sun. There were some high-risk spatial clusters of skin cancer in the study area. Further investigations are required to identify the underlying cause of the formation of these clusters.

Conclusions

Patients exposed to sunshine, especially among the male group, experienced much higher rates of cancer occurrence as compared to unexposed individuals. With a heterogeneous spatial pattern, hotspots were identified in non-sun-exposed and sun-exposed categories in the study area. Researchers and policymakers can significantly benefit from the spatial analyses of skin cancer incidence. These analyses can provide useful and timely prevention policies as well as tailored monitoring techniques in high-risk regions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00798-2.

Results of a Primary Skin-Cancer-Prevention Campaign in Early Childhood on Sun-Related Knowledge and Attitudes in Southern Hungary

Simple Summary

Primary skin-cancer-prevention campaigns among young children are important as this is the age when individuals are developing behaviors. Our aim was to evaluate sun-protection knowledge and behavior among caregivers in daycare centers and kindergartens and to determine if educational lectures are positively influential. In daycare centers, we discovered that measures of sun protection (e.g., hat, sunscreen, and shaded areas) are more likely to be available when compared to kindergartens. Knowledge regarding sun safety has improved following our initial presentation, however, not significantly. Sun safety policies did not exist in any of the facilities, presenting an urgent need for their implementation.

Abstract

Avoidance of ultraviolet (UV) exposure in early childhood is important for reducing the lifetime risk of developing skin cancer. The goal of the present prospective, multicenter pilot study was to assess the sun-protection practices in kindergartens and daycare centers and to evaluate sun protection knowledge and behavior among caregivers employed in the surveyed facilities. The study consisted of two parts. A baseline questionnaire was completed by the caregivers in relation to knowledge regarding basic sun protection and sun protection practices of the participating facilities. Afterward, a thirty-minute presentation was hosted in reference to this topic. Six months following the presentation, a follow-up questionnaire was distributed among the caregivers, evaluating the attitude-related and behavioral changes towards children. A total of 153 caregivers from five daycare centers (children between 6 months and 3 years of age) and sixteen kindergartens (children between 3 and 7 years of age) willfully participated in our study. According to our results, the main source of information regarding sun protection originated from different types of media. We found that staying in shaded areas and the use of protective clothing were not frequent in the facilities. Following our presentation regarding skin types and sunscreen use, protective measures improved, but not significantly (p = 0.222). The majority (92.31%) of caregivers distributed the information throughout their environment and also to parents. Sun protection knowledge is necessary; however, motivation among caregivers and parents and involvement of children is also relevant. Hence, a continuous, repetitive educational program regarding sun-smart behavior is deemed essential.

Developing indices to identify hotspots of skin cancer vulnerability among the Non-Hispanic White population in the United States

PURPOSE

Skin cancer is the most common, yet oftentimes preventable, cancer type in the United States. Exposure to ultraviolet radiation from sunlight is the most prominent environmental risk factor for skin cancer. Besides environmental exposure, demographic characteristics such as race, age, and socioeconomic status may make some groups more vulnerable. An exploratory spatial clustering method is described for identifying clusters of vulnerability to skin cancer incidence and mortality based on composite indices, which combine data from environmental and demographic risk factors.

METHODS

Based on county-level ultraviolet data and demographic risk factors, two vulnerability indices for skin cancer were generated using an additive percentile rank approach. With these indices, univariate local Moran's I spatial autocorrelation identified significant clusters, or hotspots, of neighboring counties with high overall vulnerability indices. Clusters were identified separately for skin cancer incidence and mortality.

RESULTS

Counties with high vulnerabilities were spatially distributed across the United States in a pattern that generally increased to the South and West. Clusters of counties with high skin cancer incidence vulnerability were mostly observed in Utah and Colorado, even with highly conservative levels of significance. Meanwhile, clusters for skin cancer mortality vulnerability were observed in southern Alabama and west Florida as well as across north Alabama, north Georgia and up through the Tennessee-North Carolina area.

CONCLUSIONS

Future skin cancer research and screening initiatives may use these innovative composite vulnerability indices and identified clusters to better target resources based on anticipated risk from underlying demographic and environmental factors.

Exogenous sex hormones, menstrual and reproductive history, and risk of non-melanoma skin cancer among women: a systematic literature review and meta-analysis

Non-melanoma skin cancers (NMSC) are more frequent among men, but women (especially those aged < 40 years) have experienced steeper growth in their incidence rates in recent years. Hormonal factors were hypothesized to be playing a role in modulating NMSC risk, but the studies published to date provided conflicting results. We systematically reviewed and meta-analysed the studies focusing on the association between hormone-related characteristics (use of exogenous sex hormones, and aspects of menstrual and reproductive history) and the risk of NMSC among women. We included observational and experimental studies published in PubMed and EMBASE until February 2020. We calculated summary relative risk (SRR) and 95% confidence intervals (CI) by applying random effects models with maximum likelihood estimation, and used the I2 statistics to quantify the degree of heterogeneity of risk estimates across studies. Eleven independent studies encompassing a total of over 30,000 NMSC cases were included in quantitative analyses. No evidence of an increased NMSC risk emerged among ever vs. never users of oral contraceptives (SRR 1.13, 95% CI 0.88-1.45) or hormones for menopause (SRR 1.09, 95% CI 0.87-1.37). Likewise, age at menarche or at menopause and parity were not associated with NMSC risk. Heterogeneity across studies was low, and pooled results were comparable between NMSC subtypes. We found no evidence that hormonal factors play a role in the pathogenesis of NMSC among women.

Sunburn frequency and risk and protective factors: a cross-sectional survey

Skin cancer prevention is at the forefront of public health as morbidity increases. Limited data exists on effective interventions to reduce sunburn frequency and modifiable risk factors. This research aims to determine an association between 1) demographic characteristics and outdoor sunburn frequency, and 2) sunburn frequency and sun-related risk and protective factors in a nationally representative, cross-sectional household survey. Of 23,430 surveys sent, 4,883 respondents reported sunburn-related data. Association between sunburns and demographic, risk, and protective factors were examined. When assessing demographic factors, potential confounding was addressed using multivariable analysis. In multivariable models, younger, non-Hispanic White respondents were more likely to report sunburn. Those with higher income were more likely to report any sunburn, but less likely to sunburn frequently. Females were less likely to report frequent sunburns. Engagement in sporting events, outdoor events, and day-to-day activities during the most recent sunburn was more commonly reported by those with frequent sunburns as compared with those with infrequent sunburns. Sun-protection interventions targeting higher-risk demographics during time spent outdoors, at sporting events, and during other day-to-day activities may be beneficial. Further insight into risk and protective behaviors for those who did not burn could be useful to guide public health interventions.

Determining Skin Cancer Protective Behaviors in the Light of the Protection Motivation Theory among Sailors in Bandar-Bushehr in the South of Iran

Background:

Skin cancer is among the most prevalent cancers in Iran and worldwide. Due to the nature of work, sailors are constantly exposed to the ultraviolet rays of the sun, which in the long run damages their skin and raises the chances of skin cancer. Thus, the present research aimed to predict the skin cancer protective behaviors among sailors in the south of Iran in the light of the protection motivation theory.

Materials and Methods:

The present analytical, cross-sectional research was conducted on 360 sailors in Bandar-Bushehr selected randomly from 4 border healthcare centers. To collect the required data, a reliable and valid questionnaire based on the protection motivation theory was used. The data were analyzed in SPSS21 using descriptive and inferential statistics including Pearson correlation coefficient and linear regression analysis.

Results:

Pearson correlation coefficient showed a statistically significant positive correlation between protection motivation, perceived severity, fear, reward on the one hand and a statistically significant negative correlation between protection motivation and rewards and response costs. All constructs of protection motivation explained 43% of the variance of skin cancer protective behaviors. Among the influential predictors, perceived self-efficacy showed to be the strongest (β=0.328).

Conclusion:

Considering the effectiveness of the protection motivation theory in determining skin cancer preventive behaviors among sailors, it can be concluded that this theory can be used as a framework in planning health education and promotion programs to motivate sailors to adopt more skin cancer protective behaviors.

Actinic keratoses in subjects from la Mitad del Mundo, Ecuador

BACKGROUND

Quito, the capital of Ecuador due to its geographical location, has a high skin cancer incidence. Actinic keratoses, as premalignant lesions, are precursors of nonmelanoma skin cancer, and the prevalence of this medical condition in the country is unknown.

METHODS

An observational, cross-sectional study was performed to assess the prevalence of actinic keratoses (AKs) in a rural area of Quito. Visual skin exams, dermoscopy and biopsy of suspicious lesions were performed.

RESULTS

A total of 254 subjects older than 40 years old (71.3% female) were enrolled. The general AK prevalence was 22.4%; in women, the prevalence was 23.6%, while in men, it was 19.4%. The prevalence rates of basocellular and squamous cell carcinomas and Bowen disease were 1.6, 0.8 and 0.4%, respectively. No statistical associations were found between AKs and the studied variables.

CONCLUSIONS

This study was the first reporting the prevalence of premalignant lesions in Ecuador. We could not demonstrate a relationship between the presence of AKs and any of the known risk factors for their development.

Giant squamous cell carcinomas of the shoulder

Giant squamous cell carcinomas (SCC) larger than 5 cm in diameter are uncommon; there is no guideline on the size of an SCC that is considered giant. Treatment may be difficult with the need for large tissue resections and complex surgical reconstruction. We report a rare case of giant squamous cell carcinoma of the shoulder attached to deep anatomic planes. The entire mass was removed, resulting in a large defect that was repaired with myocutaneous flap rotation of the latissimus dorsi. Three courses of radiotherapy were performed after surgery. Fifteen months after the operation, the patient is well and working without any local recurrence and metastasis.

Is Occupational Skin Cancer More Aggressive than Sporadic Skin Cancer?

Background: Non-melanoma skin cancer (NMSC) represents the most frequently diagnosed cancer in humans. Occupational solar UV radiation exposure is associated with a higher-risk of developing NMSC, but still Romania does not acknowledge this affliction as an occupational disease. The study aims to determine if occupationally-induced NMSC is associated with more aggressive clinical and histopathological features compared to sporadic NMSC. Material and methods: A retrospective, analytical, comparative study was conducted during 2017-2019 in a University Department of Dermato-venereology in Bucharest, Romania, with focus on patients presenting with NMSC who underwent surgical excision of lesions followed by histopathological examination, classified as outdoor or indoor workers. High-risk clinical and histopathological characteristics were analysed and correlated with outdoor UV exposure. Outcomes: The study included 51 consecutive patients diagnosed with NMSC, of which 25 outdoor workers (OW) and 26 controls as indoor workers with no occupational UV exposure background. OW presented with 21 BCC and four SCC, while controls with 22 BCC and four SCC. Males were predominant in both groups and most patients came from urban environment. The mean age value was lower for the OW group compared to controls. OW had a 4.66 times higher risk of developing NMSC with aggressive location and size χ² (1, N=51) = 6.246, p=0.013, OR=4.66 (95% CI: 1.34, 16.23) and a 24-fold risk of developing NMSC with clinically poorly defined margins χ² (1, N=51) = 21.697, p<0.001, OR=24.44 (95% CI: 5.38,110.92). The risk of developing a high-risk histopathological subtype was 15 times greater for OW χ² (1, N=51) = 13.814, p<0.001, OR=15.27 (95% CI: 2.94,79.08). Moderate to severe desmoplastic reaction was 8.57 more frequent in controls χ² (1, N=51) = 12.244, p=0.001, OR=8.57 (95% CI: 2.42, 30.30). Grades 2 and 3 of actinic elastosis were significantly associated with outdoor work (χ² (1, N=51) = 33.382, p<0.001, OR=131.25 (95% CI: 13.60, 1266.37). The presence of ulceration and pigment association of tumors on the histopathological report were not significantly associated with outdoor working. Conclusion: 1. Occupational NMSC in Romania is associated with high-risk clinical features; 2. Poorly defined borders is a significant clinical high-risk factor associated with occupational UV exposure in NMSC; 3. High-risk histopathological subtypes are more frequently encountered in outdoor workers diagnosed with NMSC compared to indoor workers with no occupational UV exposure background; 4. Occupational NMSC is associated with significantly higher grades of desmoplastic reaction and of actinic elastosis compared to indoor workers.

Non-Melanoma Skin Cancer in Outdoor Workers: A Study on Actinic Keratosis in Italian Navy Personnel

Occupational exposure to ultraviolet radiation is one of the main risk factors for non-melanoma skin cancer (NMSC) development. The most common variants of NMSC are basal cell carcinomas, squamous cell carcinomas, and actinic keratosis (AK). The latter is nowadays considered by most authors as an early squamous cell carcinoma rather than a precancerous lesion. Outdoor workers have a higher risk of developing NMSC because they spend most of the working day outside. The aim of this descriptive study was to assess the prevalence of skin lesions, especially AK, in a professional category of individuals exposed to ultraviolet (UV) radiation: the Italian Navy. From January to June 2016, a questionnaire and a total skin examination of 921 military personnel were administered by medical specialists (dermatologists) in seven different Italian Navy centres. AK was detected in 217 of 921 (23.5%) workers. Older age, outdoor occupation, longer working life, and fair skin seem to promote the development of AK. Of the 217 workers with AK, 187 (86.2%) had lesions in chronically sun-exposed skin areas. Italian Navy personnel have a high AK prevalence. Further studies are needed to investigate occupational hazards and their health effects among outdoor workers to promote protective behaviour and raise awareness of skin cancer.

Evaluating perceived threat of skin cancer and preventive measures in South Iranian sailors: A qualitative study

BACKGROUND

Sailors are exposed to sunlight as their job requires and are, in the long run, more prone to different types of skin cancer. This study aimed to explore sailors' experience of perceived threat and to show protective behaviors against sunlight in the south of Iran.

MATERIALS AND METHODS

The present follows a qualitative approach and directed content analysis in 2018-2019 among sailors who were selected purposively through an interview procedure. Finally, 22 sailors and 3 patients with skin cancer with an experience of sailing were interviewed until data satiation occurred. The data were collected through a semi-structured interview based on two constructs, perceived susceptibility and perceived severity of protection motivation theory, and were instantly transcribed and read more than once by the present researcher. Simultaneously, the data were entered into MAXQDA 10 for the primary categorization.

RESULTS

Data analysis results were classified into 5 categories and 12 subcategories: protective attempts (change of work time and use of protectives), passivity in self-protection (not showing protective behaviors and not examining skin), inadequate perception of affliction risk (beliefs hindering preventive behaviors and low sensitivity), perceived threat to personal and familial conditions (loss of peace and loss of occupational-familial positions), and threat to health (incurable disease and perceived skin disease).

CONCLUSIONS

Awareness of these factors helps planners to choose the best preventive strategies with a focus on correcting beliefs and promoting protective behaviors as well as examining and screening sailors regularly to diagnose skin cancer. Moreover, to develop practical measures of protective strategies against sunlight among sailors, the required steps should be taken. This can help to reduce the rate of work-related risks while exposed to sunlight in this population.

Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects

Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.

Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain

Background:

Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access.

Objective:

To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users.

Methods:

A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23^rd to June 13^th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer.

Results:

A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended.

Conclusions:

Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening.

Sunscreen products: Rationale for use, formulation development and regulatory considerations

The association of sunrays with skin damage have been known since medieval times. The description of the electromagnetic spectrum facilitated the identification of the ultraviolet light spectrum as being responsible for skin damage resulting from prolonged skin exposure. Sunscreens have been used since ancient civilizations with various measures to limit exposure to sun exposure being employed. Awareness of the risks associated with sunrays has been increasing in the last century, and as a result, the science, technologies, and formulation have advanced significantly. The use of sunscreen products continues rising as government health agencies seek to contain increasing cases of UV induced melanomas. Recreational sunbathing and artificial tanning have increased the risk for these diseases significantly. This review article sought to expound the scientific basis of sunscreen use, the classification, formulation, quality control and regulation across the different countries around the world. The literature review was conducted on Google scholar, PubMed, SCOPUS, Cochrane, BMJ, SCIELO among others.

Skin cancer incidence in rural workers at a reference hospital in western Paraná

BACKGROUND

Skin cancer is common in Brazil and is related to sun exposure, among other risk factors. There are no data on the incidence of malignant skin neoplasm in rural workers in western Paraná.

OBJECTIVE

To analyze the incidence and profile of rural workers who were diagnosed with skin cancer at a reference service in Cascavel, western Paraná, in the last five years (2011-2016).

METHODS

This retrospective cross-sectional study was carried out through a review of the anatomopathological reports of rural workers diagnosed with skin cancer at Cascavel Oncology Center (CEONC), in Cascavel. The following variables were collected: year of diagnosis, age, gender, injury location and histological subtype.

RESULTS

A total of 681 cases of malignant epithelial neoplasia were identified, with a higher frequency in the 61-70 age group. Data analysis showed an increase of about 210% in the occurrence of skin cancers in the last 5 years. The cephalic region was the most affected, and the most common histological subtype was nodular basal cell carcinoma. There was no association between gender and location.

STUDY LIMITATIONS

This is a retrospective study and analysis of a secondary data bank.

CONCLUSION

This study is a regional estimation of the incidence of cutaneous neoplasms and provides evidence of a considerable increase in the number of diagnoses in rural workers from western Paraná, Brazil. Moreover, it is possible to conclude that the sample group studied is at risk of developing skin cancer.

Single center evidence for the treatment of basal cell carcinoma of the head and neck

AIM

Basal Cell Carcinoma (BCC) alone accounts for 80% of cases of non-melanoma skin cancer (NMSC), which characteristically develops on sun-exposed skin. Indeed the most common site of BCC is the head and neck region (80%). The purpose of this study to review the experience of our center with BCC in the head and neck region to report the sites of occurrence and treatment.

MATERIALS AND METHOD

We retrospectively reviewed 77 patients with BCC of the head and neck, who revived surgical treatment within our plastic surgery division. Basic demographic data, cancer site and size, surgical treatment and histological data were collected. The mean follow-up period was 12 months.

RESULTS

The study population included 37 males and 40 females, with a mean age of 74.12 years. The nasal unit was the main site of BCC (31.82%), followed by the periorbital (13.64%) and cervical (12.5%) units. Primary closure was the main surgical procedure performed (72.5%), followed by local flap (26.1%) and full-thickness skin grafts (1.4%). The safety resection margin ranged from 4.5 to 9 mm, with a 98.7% complete removal rate. Neither recurrence nor any newly-developed lesions were reported during follow-up in any patient.

DISCUSSION

Our work reflects the shift in the incidence of BCC, which now seems to be more frequent in females. Furthermore, our data strengthens the association between UVR exposure and BCC, confirms its predilection to occur on the nasal unit and validates surgical excision as the gold standard treatment for skin cancer.

Implementation of Occupational Sun Safety at a 2-Year Follow-Up in a Randomized Trial: Comparison of Sun Safe Workplaces Policy Intervention to Attention Control

PURPOSE

Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention.

DESIGN

Two-year follow-up assessment in a randomized pretest-posttest controlled design.

SETTING

Local government organizations with workers in public safety, public works, and parks and recreation.

PARTICIPANTS

Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers.

INTERVENTION

Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education.

MEASURES

Observations of SSW messages and sun safety items and surveys on organizations' communication and actions on sun safety.

ANALYSIS

Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed).

RESULTS

At intervention worksites, more SSW messages ( P < .001) and sun safety items ( P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen ( P = .005) and communicated about sun safety ( P < .001); and more workers recalled receiving sun safety messages ( P < .001) and sun safety training ( P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats ( P = .009), long work pants ( P = .017), and shade structures ( P = .036). Older workers received the most written messages ( P = .015).

CONCLUSIONS

Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

Actinic Keratosis and Non-Invasive Diagnostic Techniques: An Update

Actinic keratosis represents the earliest manifestation of non-melanoma skin cancer. Because of their risk of progression to invasive squamous cell carcinoma, an earlier diagnosis and treatment are mandatory. Their diagnosis sometimes could represent a challenge even for expert dermatologists. Dermoscopy, confocal laser microscopy and optical coherence tomography could help clinicians in diagnosis.

Occupational dermatoses reported in Brazil from 2007 to 2014

BACKGROUND

Occupational diseases are very prevalent in the world, especially in developing countries. Occupational dermatoses are responsible for most of these cases. However, epidemiological studies are rare in Brazil.

OBJECTIVES

To verify the panorama of occupational skin diseases in Brazil describing frequencies of work-related dermatoses and their sociodemographic and occupational patterns.

METHODS

We used retrospective data from the Notifiable Diseases Information System, (from 2007-2014) tabulated with the Tab program for Windows - TabWin12. We used intentional non-probability sampling and sequential selection, considering all notified occupational dermatoses.

RESULTS

All cases of occupational dermatoses referred to in the period were analyzed (n = 4710). Males and the age group of 35-49 years were the most affected. The most affected body area was the upper limb (34.2%) and the hand (25.4%). The "causative agent" field in the forms was not filled in 69.4% of cases, with chrome as the most prevalent cause reported (11.8%). ICD-10 codes more prevalent were L23, L24, and L25, corresponding to 34.2% of the sample. In total, 29% of patients needed to take a sick leave. No cases evolved to death and there were 0.2% of total as permanent disability.

STUDY LIMITATIONS

The amount of missing information for various items in the system draws attention.

CONCLUSIONS

Treatment of patients with occupational dermatitis include the identification and removal of the causative agent and specific treatment of the disease. Diagnosis delay in cases of occupational dermatoses brings social and financial consequences to the work and life of workers.

TRAF1 Is Critical for DMBA/Solar UVR-Induced Skin Carcinogenesis

TRAF1 is a member of the TRAF protein family, which regulates the canonical and noncanonical NF-κB signaling cascades. Although aberrant TRAF1 expression in tumors has been reported, the role of TRAF1 remains elusive. Here, we report that TRAF1 is required for solar UV-induced skin carcinogenesis. Immunohistochemical analysis showed that TRAF1 expression is up-regulated in human actinic keratosis and squamous cell carcinoma. In vivo studies indicated that TRAF1 expression levels in mouse skin are induced by short-term solar UV irradiation, and a long-term skin carcinogenesis study showed that deletion of TRAF1 in mice results in a significant inhibition of skin tumor formation. Moreover, we show that TRAF1 is required for solar UV-induced extracellular signal-regulated kinase-5 (ERK5) phosphorylation and the expression of AP-1 family members (c-Fos/c-Jun). Mechanistic studies showed that TRAF1 expression enhances the ubiquitination of ERK5 on lysine 184, which is necessary for its kinase activity and AP-1 activation. Overall, our results suggest that TRAF1 mediates ERK5 activity by regulating the upstream effectors of ERK5 and also by modulating its ubiquitination status. Targeting TRAF1 function might lead to strategies for preventing and treating skin cancer.

Transcriptome Analysis Identifies the Dysregulation of Ultraviolet Target Genes in Human Skin Cancers

Exposure to ultraviolet radiation (UVR) is a major risk factor for both melanoma and non-melanoma skin cancers. In addition to its mutagenic effect, UVR can also induce substantial transcriptional instability in skin cells affecting thousands of genes, including many cancer genes, suggesting that transcriptional instability may be another important etiological factor in skin photocarcinogenesis. In this study, we performed detailed transcriptomic profiling studies to characterize the kinetic changes in global gene expression in human keratinocytes exposed to different UVR conditions. We identified a subset of UV-responsive genes as UV signature genes (UVSGs) based on 1) conserved UV-responsiveness of this subset of genes among different keratinocyte lines; and 2) UV-induced persistent changes in their mRNA levels long after exposure. Interestingly, 11 of the UVSGs were shown to be critical to skin cancer cell proliferation and survival. Through computational Gene Set Enrichment Analysis, we demonstrated that a significant portion of the UVSGs were dysregulated in human skin squamous cell carcinomas, but not in other human malignancies. This highlights the potential and specificity of the UVSGs in clinical diagnosis of UV damage and stratification of skin cancer risk.

Vitamin D Intake and Risk of Skin Cancer in US Women and Men

Previous studies suggested a protective effect of vitamin D against skin cancer development. However, epidemiologic studies on orally taken vitamin D and risk of skin cancer (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], and melanoma) are few. We prospectively evaluated whether total, dietary and supplemental vitamin D intake were associated with skin cancer risk based on 63,760 women in the Nurses' Health Study (1984–2010) and 41,530 men in the Health Professionals Follow-up Study (1986–2010). Dietary information on vitamin D intake was assessed every 2 to 4 years during the follow-up and cumulative averaged intake was used. We used Cox proportional hazard models to compute the hazard ratios (HR) and 95% confidence intervals (CI). Pooled HR of cohort-specific results were calculated using a random-effects model. During the follow-up, we documented 20,840 BCC, 2,329 SCC and 1,320 melanoma cases. Vitamin D consumption was not associated with the risk of SCC or melanoma but was modestly positively associated with BCC; the pooled HRs of BCC for extreme quintiles of vitamin D intake were 1.10 (95%CI = 1.05–1.15; P_trend = 0.05) for total vitamin D and 1.13 (95% CI = 1.07 to 1.20; P_trend <0.01) for dietary vitamin D. Stratified analysis according to sun exposure related factors showed similar results. In conclusion, vitamin D intake was positively associated with risk of BCC, while null associations were found with SCC and melanoma. Our data do not support a beneficial role of orally taken vitamin D on skin cancer carcinogenesis.

Sun safety knowledge and practice in UK postal delivery workers

BACKGROUND

Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK.

AIMS

To describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group.

METHODS

Postal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics.

RESULTS

A total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics.

CONCLUSIONS

There is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated.

Retrospective clinicopathological study of 129 cancerous and 18 precancerous lesions of the eyelids in North-Western Greece

This study aimed to present precancerous and cancerous epithelial eyelid lesions, their histopathological features, and possible correlations with clinical parameters. The retrospective study included 147 formalin-fixed, paraffin-embedded samples. We studied precancerous and cancerous epithelial eyelid lesions. Preneoplastic tumors were represented by 12 actinic keratoses and 6 in situ squamous cell carcinomas (Bowen disease) and skin epithelial tumors by 119 basal and 10 squamous cell carcinomas. We recorded the clinicomorphological and histopathological features of the specimens and investigated possible correlations. In our study, the vast majority of pre-malignant and malignant tumors occurred in advanced age (mean age of occurrence: 70.18 years). The data analysis showed that inflammation in patients with basal cell carcinoma (BCC) positively correlated with advanced age (p < 0.01), tumor diameter (p < 0.05), and the appearance of ulceration (p < 0.001). A prevalence of female sex was noted in the BCC group. We also found that inflammation with or without the presence of ulceration was more commonly seen in carcinomatous lesions than in preneoplastic lesions (p < 0.05). Inflammation occurrence is present in high proportions in the tumors studied and correlates with some clinicopathological parameters such as the age of patients, the mean tumor diameter, and the presence of ulceration. The comparison between premalignant and malignant conditions showed that inflammation probability increases as we move toward the more aggressive tumor phenotypes.

The Sustainability of an Occupational Skin Cancer Prevention Program

OBJECTIVE

Sustainability of prevention programs is a public health goal.

METHODS

The effectiveness of Go Sun Smart, an occupational skin cancer prevention program, was evaluated 5 to 7 years out from the conclusion of a controlled randomized dissemination trial that compared an enhanced versus basic dissemination strategy at 53 ski areas enrolled in the trial.

RESULTS

Employees (n = 2940) at ski areas in the enhanced condition reported fewer sunburns but did not differ from employees in the basic condition on other sun-protection measures. Significant differences for all sun-protection practices were identified at ski areas that displayed nine or more Go Sun Smart materials or a combined total of nine or more Go Sun Smart and other sun safety messages.

CONCLUSIONS

Exposure to prevention messages is an important determinant of program effectiveness and potentially of program sustainability.

Brazilian consensus on photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Occupational exposure to ultraviolet radiation and risk of non-melanoma skin cancer in a multinational European study

Background

Studies suggest that ambient sunlight plays an important role in the pathogenesis of non-melanoma skin cancers (NMSC). However, there is ongoing controversy regarding the relevance of occupational exposure to natural and artificial ultraviolet radiation (UV) radiation.

Objectives

We investigated potential associations between natural and artificial UV radiation exposure at work with NMSC in a case-control study conducted in Hungary, Romania, and Slovakia.

Methods

Occupational exposures were classified by expert assessment for 527 controls and 618 NMSC cases (515 basal cell carcinoma, BCC). Covariate information was collected via interview and multiple logistic regression models were used to assess associations between UV exposure and NMSC.

Results

Lifetime prevalence of occupational exposure in the participants was 13% for natural UV radiation and 7% for artificial UV radiation. Significant negative associations between occupational exposure to natural UV radiation and NMSC were detected for all who had ever been exposed (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.27–0.80); similar results were detected using a semi-quantitative metric of cumulative exposure. The effects were modified by skin complexion, with significantly decreased risks of BCC among participants with light skin complexion. No associations were observed in relation to occupational artificial UV radiation exposure.

Conclusions

The protective effect of occupational exposure to natural UV radiation was unexpected, but limited to light-skinned people, suggesting adequate sun-protection behaviors. Further investigations focusing on variations in the individual genetic susceptibility and potential interactions with environmental and other relevant factors are planned.

Advanced basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin malignancy worldwide. Ultraviolet light exposure is the best known exogenous factor in BCC development. This is also the target for primary prevention. Advanced BCC include locally advanced tumors and metastatic tumors. Prognosis is worse compared to stage I and II BCCs. Mohs or micrographically controlled surgery is the gold standard of treatment. In patients with tumors that cannot be completely removed radiotherapy was the only alternative in the past. More recently new drugs for targeted therapy of signaling pathways like sonic hedgehog or epidermal growth factor receptor became available. More small molecules are under investigation. Since the complete response rates are limited, future research has to evaluate their combination with surgery.

Epigenetic repression of LEDGF during UVB exposure by recruitment of SUV39H1 and HDAC1 to the Sp1-responsive elements within LEDGF promoter CpG island

Expression level of lens epithelial derived growth factor (LEDGF) is vital for LEDGF-mediated cell survival and cytoprotection against proapoptotic stimuli. We previously demonstrated that LEDGF is transcriptionally regulated by Sp1-responsive elements within a CpG island in the LEDGF promoter. Herein, we report on the existence of epigenetic signaling involved in the repression of LEDGF transcription in lens epithelial cells (LECs) facing UVB. UVB exposure led to histone H3 dimethylation and deacetylation at its CpG island, where a histone deacetylase/histone methylase (HDAC1/SUV39H1) complex was recruited. Exposure of LECs to UVB stress altered LEDGF protein and mRNA expression as well as promoter activity, while failing to methylate the CpG island. These events were correlated with increased reactive oxygen species (ROS) and increased cell death. LEDGF promoter activity and expression remained unaltered after 5-Aza treatment, but were relieved with tricostatin A, an inhibitor of HDACs. Expression analysis disclosed that UVB radiation altered the global expression levels of acetylated histone proteins, diminished total histone acetyltransferase (HAT) activity and increased HDAC activity and HDAC1 expression. In silico analysis of LEDGF proximal promoter and ChIP analyses disclosed HDAC1/SUV39H1 complex anchored to the -170/-10 nt promoter regions at Sp1-responsive elements and also attenuated Sp1 binding, resulting in HDAC1- and SUV39H1-dependent deacetylation and dimethylation of H3 at K9. Acetylation of H3K9 was essential for LEDGF active transcription, while enrichment of H3K9me2 at Sp1-responsive elements within CpGs (-170/-10) by UVB radiation repressed LEDGF transcription. Our study may contribute to understanding diseases associated with LEDGF aberrant expression due to specific epigenetic modifications, including blinding disorders.