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Neuberger A, Menzer C, Volk N, Enk AH, Hadaschik EN, Lonsdorf AS. Expression of p53 up-regulated modulator of apoptosis (PUMA) in non-melanoma skin cancer of long-term immunosuppressed solid organ transplant recipients compared to immunocompetent patients. Eur J Dermatol 2021; 31:609-15. [PMID: 34903507 DOI: 10.1684/ejd.2021.4133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The risk of UV radiation (UVR)-induced non-melanoma skin cancer (NMSC) is dramatically increased in immunosuppressed organ transplant recipients compared to immunocompetent patients. In the skin, p53 up-regulated modulator of apoptosis (PUMA) is a central regulator of apoptosis in response to UVR damage and immune response regulation. Data on the expression of PUMA in patients with NMSC relative to immune status is limited To study differences in the expression and distribution of PUMA in cutaneous SCC and BCC by immunohistochemistry between immunocompetent patients and organ transplant recipients, and the effect of CsA-containing immunosuppressive maintenance regimens on this expression. PUMA expression in SCC (n = 34) and BCC (n = 20) was analysed comparatively by immunohistochemical staining in matched cohorts of 27 immunocompetent patients and 27 organ transplant recipients SCC and BCC showed unequivocal positive PUMA expression, however, there was no significant difference in NMSC between organ transplant recipients and immunocompetent patients. A 17% reduction in staining score for PUMA in SCC, but not in BCC, of organ transplant recipients treated with a cyclosporin (CsA)-containing regimen was noted compared to organ transplant recipients without chronic CsA intake (p = 0.0381) PUMA expression in SCC, but not BCC, is significantly reduced by CsA-containing therapy, suggesting a disturbance of apoptosis by iatrogenic immunosuppression with a divergent impact on SCC and BCC.
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Campagna R, Pozzi V, Sartini D, Salvolini E, Brisigotti V, Molinelli E, Campanati A, Offidani A, Emanuelli M. Beyond Nicotinamide Metabolism: Potential Role of Nicotinamide N-Methyltransferase as a Biomarker in Skin Cancers. Cancers (Basel) 2021; 13. [PMID: 34638427 DOI: 10.3390/cancers13194943] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 02/01/2023] Open
Abstract
Skin cancers (SC) collectively represent the most common type of malignancy in white populations. SC includes two main forms: malignant melanoma and non-melanoma skin cancer (NMSC). NMSC includes different subtypes, namely, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), and keratoacanthoma (KA), together with the two pre-neoplastic conditions Bowen disease (BD) and actinic keratosis (AK). Both malignant melanoma and NMSC are showing an increasing incidence rate worldwide, thus representing an important challenge for health care systems, also because, with some exceptions, SC are generally characterized by an aggressive behavior and are often diagnosed late. Thus, identifying new biomarkers suitable for diagnosis, as well as for prognosis and targeted therapy is mandatory. Nicotinamide N-methyltransferase (NNMT) is an enzyme that is emerging as a crucial player in the progression of several malignancies, while its substrate, nicotinamide, is known to exert chemopreventive effects. Since there is increasing evidence regarding the involvement of this enzyme in the malignant behavior of SC, the current review aims to summarize the state of the art as concerns NNMT role in SC and to support future studies focused on exploring the diagnostic and prognostic potential of NNMT in skin malignancies and its suitability for targeted therapy.
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Caini S, Gnagnarella P, Stanganelli I, Bellerba F, Cocorocchio E, Queirolo P, Bendinelli B, Saieva C, Raimondi S, Gandini S. Vitamin D and the Risk of Non-Melanoma Skin Cancer: A Systematic Literature Review and Meta-Analysis on Behalf of the Italian Melanoma Intergroup. Cancers (Basel) 2021; 13:4815. [PMID: 34638299 DOI: 10.3390/cancers13194815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/23/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Vitamin D has been extensively studied in relation to cancer risk at several body sites, but its relationship with non-melanoma skin cancer (NMSC), the most frequent malignancy in humans, is still unclear. Here, we performed a systematic literature search and meta-analysis of published studies and did not find convincing evidence that a causal association exists between vitamin D intake (from foods and supplements), vitamin D blood concentration, or polymorphisms of the genes coding for the vitamin D receptor and binding protein, and NMSC risk. Abstract We aimed to provide a comprehensive overview of the link between vitamin D and non-melanoma skin cancer (NMSC). For this purpose, we conducted a systematic literature review (updated to 3 February 2021) and meta-analysis of the studies reporting on the association between vitamin D intake (from diet and supplements) and blood concentration, polymorphisms of the vitamin D receptor (VDR) and vitamin D binding protein (VDBP) genes, and the risk of NMSC. Random effects meta-analysis models were fitted to merge study-specific risk estimates into summary relative risk (SRR) and corresponding 95% confidence intervals (CI). Twenty-four studies altogether were included. There was a suggestive association between increasing serum/plasma vitamin D concentration and NMSC risk (SRR for highest vs. lowest concentration 1.67, 95%CI 0.61–4.56), although with large heterogeneity across studies (I2 = 91%). NMSC risk was associated with highest vitamin D intake in observational studies but not in clinical trials. Finally, there was no significant association between any polymorphism of the VDR and VDBP genes and NMSC risk. In conclusion, no strong relationship between vitamin D metabolism and NMSC risk appears to exist according to our systematic review and meta-analysis, although some findings are worthy of further investigation.
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104
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Boutros A, Cecchi F, Tanda ET, Croce E, Gili R, Arecco L, Spagnolo F, Queirolo P. Immunotherapy for the Treatment of Cutaneous Squamous Cell Carcinoma. Front Oncol 2021; 11:733917. [PMID: 34513710 PMCID: PMC8427439 DOI: 10.3389/fonc.2021.733917] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022] Open
Abstract
Cutaneous squamous cell carcinoma (CSCC) accounts for approximately 20% of all keratinocytic tumors. In most cases, the diagnosis and treatments are made on small, low-risk lesions. However, in about 5% of cases, CSCC may present as either locally advanced or metastatic (i.e. with locoregional lymph nodes metastases or distant localizations). Prior to the introduction of immunotherapy in clinical practice, the standard treatment of advanced CSCC was not clearly defined, and up to 60% of patients received no systemic therapy. Thanks to a strong pre-clinical rationale, clinical trials led to the FDA (Food and Drug Administration) and EMA (European Medicines Agency) registration of cemiplimab, a PD-1 inhibitor that achieved encouraging results in terms of objective response, overall survival, and quality of life. Subsequently, the anti-PD-1 pembrolizumab received the approval for the treatment of advanced CSCC by the FDA only. In this review, we will focus on the definition of advanced CSCC and on the current and future therapeutic options, with a particular regard for immunotherapy.
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Affiliation(s)
- Andrea Boutros
- Oncologia Medica 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
| | - Federica Cecchi
- Oncologia Medica 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Enrica Teresa Tanda
- Oncologia Medica 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy.,Genetics of Rare Cancers, Department of Internal Medicine and Medical Specialties, University of Genoa, Genova, Italy
| | - Elena Croce
- Oncologia Medica 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
| | - Riccardo Gili
- Oncologia Medica 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy.,U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Spagnolo
- Oncologia Medica 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology (IEO), European Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
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105
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Bezugly A, Rembielak A. The use of high frequency skin ultrasound in non-melanoma skin cancer. J Contemp Brachytherapy 2021; 13:483-91. [PMID: 34484364 DOI: 10.5114/jcb.2021.108603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
Ultrasound (US) or sonography is the most common diagnostic non-invasive imaging method, which is estimated to account for more than a third of all diagnostic procedures used in medical practice. Traditionally, US frequencies used in diagnostic radiology range from 1 MHz to approximately 16 MHz. Visualization of skin morphology requires US frequencies from 20 to 100 MHz, and is called a "high frequency ultrasound" (HFUS). HFUS has been explored in normal skin and in various skin pathologies. It has been found useful in differentiation diagnosis of infiltrative (perivascular) and exudative inflammation, hypertrophic or normotrophic scars, keloids, and in skin atrophy. Moreover, it has been used to support diagnosis and management of skin tumors. In skin oncology, HFUS can provide essential information on tumors' size and margins, particularly the depth of invasion. Such information are crucial in deciding on the form of treatment (e.g., photodynamic therapy, radiotherapy, brachytherapy), computed tomography (CT)-based planning treatment (e.g., superficial brachytherapy), and in skin monitoring after treatment, in addition to clinical examination.
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106
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Tong E, Phan K, Smith SD. Perils & pearls of purchasing sun protection over the internet: A google project. Photodermatol Photoimmunol Photomed 2021; 37:380-385. [PMID: 33561887 DOI: 10.1111/phpp.12668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND/PURPOSE Sunscreen use has been shown to reduce the incidence of skin cancers. Internet purchasing allows access to internationally sourced sunscreens, despite varying accepted active ingredients and regulations around the world. AIMS/OBJECTIVES To determine the compliance of international sunscreen products advertised on the internet with the current Australian sunscreen standard (AS/NZS 2604:2012). MATERIALS AND METHODS Six sunscreen-related search queries were executed on Google between January-November 2018. Qualitative analysis of the search results to determine compliance with the current Australian sunscreen standard (AS/NZS 2604:2012) was performed by collecting descriptive data, including listed active ingredients of each advertised product. These were compared against the AS/NZS 2604:2012 list of permitted active ingredients. The compliance status of each product, and reasons for non-compliance were annotated. A multiple regression contingency table test was performed to determine whether compliance was associated with the products' country of origin, and a post hoc analysis was performed to identify countries with significant differences in discrepancy in compliance rate. RESULTS Execution of the sunscreen-related search queries on Google generated 1350 results. Only 613 of the 1291 (47.5%) included products were compliant with the AS/NZS 2604:2012 permitted sunscreen active ingredients. 552 of 1291 products were non-compliant due to insufficient information advertised. Australia, India and South Korea had significantly lower than expected compliance rates. CONCLUSIONS Online marketing of sunscreen products from other countries has a significantly lower than expected compliance rate with the AS/NZS 2604:2012 permitted sunscreen active ingredients, with many lacking the disclosure of the active ingredients. Advertising regulations for online suppliers need to be tightened to ensure that online consumers purchasing sunscreen products can make informed decisions, as the international E-commerce market rapidly expands.
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Affiliation(s)
- Elissa Tong
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Saxon D Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
- The Dermatology and Skin Cancer Centre, Gosford, NSW, Australia
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107
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Gambichler T, Ganjuur N, Tannapfel A, Vogt M, Scholl L, Abu Rached N, Bruckmüller S, Skrygan M, Becker JC, Käfferlein HU, Brüning T, Lang K. Mismatch Repair Protein Expression and Microsatellite Instability in Cutaneous Squamous Cell Carcinoma. ACTA ACUST UNITED AC 2021; 28:3316-22. [PMID: 34590599 DOI: 10.3390/curroncol28050287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
There exist relatively sparse and conflicting data on high-level microsatellite instability (MSI-H) and deficient mismatch repair (dMMR) in cutaneous malignancies. We aimed to determine the expression profiles of MMR proteins (MSH2, MSH6, MLH1, and PMS2) in different progression stages of cutaneous squamous cell carcinoma (cSCC, 102 patients in total) by immunohistochemistry, and search for MSI-H in patients with low-level MMR or dMMR using multiplex-PCR. Low-level MMR protein expression was observed in five patients: One patient with primary cSCC < 2 mm thickness and low-level MLH1, three patients with primary cSCC > 6 mm (including one with low-level MSH2, as well as MSH6 expression, and two with low-level PMS2), and one patient with a cSCC metastasis showing low-level MSH2 as well as MSH6. Intergroup protein expression analysis revealed that MLH1 and MSH2 expression in actinic keratosis was significantly decreased when compared to Bowen’s disease, cSCC < 2 mm, cSCC > 6 mm, and cSCC metastasis. In cases with low-level MMR, we performed MSI-H tests revealing three cases with MSI-H and one with low-level MSI-L. We found low-level MMR expression in a small subset of patients with invasive or metastatic cSCC. Hence, loss of MMR expression may be associated with tumour progression in a small subgroup of patients with non-melanoma skin cancer.
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108
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Sendín-Martin M, Durán-Romero AJ, Martin-Carrasco P, Conejo-Mir J, Pereyra-Rodriguez JJ. Mortality associated with non-melanoma skin cancer in Spain from 1979 to 2018: trends and age-adjusted rates. Eur J Dermatol 2021; 31:ejd.2021.4110. [PMID: 34463287 DOI: 10.1684/ejd.2021.4110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-melanoma skin cancers (NMSCs) are the most frequent group of malignant tumours worldwide. Objectives: The aim of the present research was to analyse mortality associated with NMSC in Spain between 1979 and 2018 and highlight changes regarding trend in mortality and differences according to age groups and gender. Death records and mid-year population data were collected from the National Statistics Institute. Age-standardized mortality rates were calculated. Significant changes in mortality trends were identified using Joinpoint regression. The independent effects of age, period and cohort and potential years of life lost due to NMSC were also analysed. Mortality rates associated with NMSC in Spain were reported as 2.49 per 100,000 inhabitants in 1979 (95% CI: 2.24-2.77) and 1.27 per 100,000 inhabitants in 2018 (95% CI; 1.16-1.39) for the overall population. Women who were born after the 70 s showed a significant increase in relative risk of death due to NMSC. Mortality associated with NMSC in Spain shows a decreasing overall trend that appears to have stabilized since 2005, with the exception of women between 35 and 64 years old.
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Affiliation(s)
| | | | | | - Julian Conejo-Mir
- Dermatology Department. Hospital Universitario Virgen del Rocío. Sevilla, Spain
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Venanzi Rullo E, Maimone MG, Fiorica F, Ceccarelli M, Guarneri C, Berretta M, Nunnari G. Non-Melanoma Skin Cancer in People Living With HIV: From Epidemiology to Clinical Management. Front Oncol 2021; 11:689789. [PMID: 34422644 PMCID: PMC8371466 DOI: 10.3389/fonc.2021.689789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
Skin cancers represent the most common human tumors with a worldwide increasing incidence. They can be divided into melanoma and non-melanoma skin cancers (NMSCs). NMSCs include mainly squamous cell (SCC) and basal cell carcinoma (BCC) with the latest representing the 80% of the diagnosed NMSCs. The pathogenesis of NMSCs is clearly multifactorial. A growing body of literature underlies a crucial correlation between skin cancer, chronic inflammation and immunodeficiency. Intensity and duration of immunodeficiency plays an important role. In immunocompromised patients the incidence of more malignant forms or the development of multiple tumors seems to be higher than among immunocompetent patients. With regards to people living with HIV (PLWH), since the advent of combined antiretroviral therapy (cART), the incidence of non-AIDS-defining cancers (NADCs), such as NMSCs, have been increasing and now these neoplasms represent a leading cause of illness in this particular population. PLWH with NMSCs tend to be younger, to have a higher risk of local recurrence and to have an overall poorer outcome. NMSCs show an indolent clinical course if diagnosed and treated in an early stage. BCC rarely metastasizes, while SCC presents a 4% annual incidence of metastasis. Nevertheless, metastatic forms lead to poor patient outcome. NMSCs are often treated with full thickness treatments (surgical excision, Mohs micro-graphic surgery and radiotherapy) or superficial ablative techniques (such as cryotherapy, electrodesiccation and curettage). Advances in genetic landscape understanding of NMSCs have favored the establishment of novel therapeutic strategies. Concerning the therapeutic evaluation of PLWH, it’s mandatory to evaluate the risk of interactions between cART and other treatments, particularly antiblastic chemotherapy, targeted therapy and immunotherapy. Development of further treatment options for NMSCs in PLWH seems needed. We reviewed the literature after searching for clinical trials, case series, clinical cases and available databases in Embase and Pubmed. We review the incidence of NMSCs among PLWH, focusing our attention on any differences in clinicopathological features of BCC and SCC between PLWH and HIV negative persons, as well as on any differences in efficacy and safety of treatments and response to immunomodulators and finally on any differences in rates of metastatic disease and outcomes.
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Affiliation(s)
- Emmanuele Venanzi Rullo
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Grazia Maimone
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Fiorica
- Department of Radiation Oncology and Nuclear Medicine, State Hospital "Mater Salutis" Azienda Unità Locale Socio Sanitaria (AULSS) 9, Legnago, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Claudio Guarneri
- Unit of Dermatology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Massimiliano Berretta
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Almadori G, De Corso E, Settimi S, Di Cintio G, Mele DA, Brigato F, Paludetti G, Salgarello M. When is a surgical multidisciplinary approach required in the management of head and neck non-melanoma skin cancer and in advanced head and neck pathologies involving skin? ACTA ACUST UNITED AC 2021; 41:S145-S157. [PMID: 34060530 PMCID: PMC8172116 DOI: 10.14639/0392-100x-suppl.1-41-2021-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
Non-melanoma Skin cancer, including cutaneous squamous cell carcinoma and basal cell carcinoma, is the most common form of malignancy in the Caucasian population, and the skin of the head and neck is the site most involved. They should not be underestimated; in particular, high-risk lesions and advanced skin cancers require accurate diagnostic work up, aggressive surgical treatment and should be managed by the head and neck surgeon, the dermatologist and the plastic surgeon. Cutaneous head-neck malignancies are often overlooked or not routinely treated with a multidisciplinary surgical approach. Similarly, for primary head and neck cancers with involvement of surrounding skin, the involvement of the dermatologist and the plastic surgeon could better define an adequate diagnosis and treatment planning. The management of these patients presents both therapeutic and ethical problems, because the poor prognosis is burdened by facial disfigurement, open malodorous wounds and intractable pain. Therefore, in patients with advanced disease that is not candidate to radical surgery, palliative surgery with flap reconstruction could take place and could be proposed to improve quality of life.
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Affiliation(s)
- Giovanni Almadori
- Cervico-Facial Oncological Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Eugenio De Corso
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Settimi
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Di Cintio
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Antonio Mele
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Brigato
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marzia Salgarello
- Plastic and Reconstructive Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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111
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Sierro TJ, Blumenthal LY, Hekmatjah J, Chat VS, Kassardjian AA, Read C, Armstrong AW. Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: A population-based study. J Am Acad Dermatol 2021; 86:373-378. [PMID: 34246700 DOI: 10.1016/j.jaad.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND As the United States becomes more diverse, determining differences in health care utilization and costs in the management of skin cancers is fundamental to decision-making in health care resource allocation and improving care for underserved populations. OBJECTIVE To compare health care use and costs among non-Hispanic White, Hispanic White, and non-Hispanic Black patients with keratinocyte carcinoma. METHODS A nationwide cross-sectional study was performed using Medical Expenditure Panel Survey data from 1996 to 2015. RESULTS Among 54,503,447 patients with keratinocyte carcinoma (weighted) over a 20-year period, 53,134,351 (97%) were non-Hispanic White; 836,030 (1.5%) were Hispanic White; and 170,755 (0.3%) were non-Hispanic Black. Compared to non-Hispanic White patients, Hispanic White patients had significantly more ambulatory visits per person per year (5.4 vs 3.5, P = .003). Compared to non-Hispanic White patients, non-Hispanic Black patients had significantly more ambulatory visits (13.1 vs 3.5, P = .027) and emergency department visits (2.3 vs 1.1, P < .001), and incurred significantly higher ambulatory costs ($5089 vs $1131, P = .05), medication costs ($523 vs $221, P = .022), and total costs per person per year ($13,430 vs $1290, P = .032). LIMITATIONS Data for squamous cell carcinomas and basal cell carcinomas are combined. CONCLUSIONS Keratinocyte carcinoma was more costly to treat and required more health care resources in non-Hispanic Black and Hispanic White patients than in non-Hispanic White patients.
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Affiliation(s)
- Tiffany J Sierro
- University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Joshua Hekmatjah
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Vipawee S Chat
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Ari A Kassardjian
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Charlotte Read
- University of Southern California Keck School of Medicine, Los Angeles, California; Department of Medicine, Imperial College London, London, United Kingdom
| | - April W Armstrong
- University of Southern California Keck School of Medicine, Los Angeles, California.
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112
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Kurzhals JK, Graf T, Boch K, Grzyska U, Frydrychowicz A, Zillikens D, Terheyden P, Langan EA. Serum Troponin T Concentrations Are Frequently Elevated in Advanced Skin Cancer Patients Prior to Immune Checkpoint Inhibitor Therapy: Experience From a Single Tertiary Referral Center. Front Med (Lausanne) 2021; 8:691618. [PMID: 34291066 PMCID: PMC8288046 DOI: 10.3389/fmed.2021.691618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Immune checkpoint inhibitor (ICI) therapy has revolutionized the treatment of several human malignancies, particularly metastatic skin cancer. However, immune-related myocarditis (irM), an immune-mediated adverse event (irAE), is often fatal. In the absence of a reliable biomarker, measurement of pre-ICI therapy serum troponin concentration has been proposed to identify patients at risk of developing irM, although real-world studies examining this strategy are lacking. Thus, we retrospectively analyzed the case records of all patients who commenced ICI therapy between January 2018 and December 2019 in a single university skin cancer center (n = 121) to (i) determine the incidence of irM, (ii) establish the frequency of pretreatment serum hsTnT elevations, and (iii) to establish whether this identified patients who subsequently developed irM. Only one patient developed irM, resulting in an overall incidence of 0.8%. Pretreatment hsTnT was measured in 47 patients and was elevated in 13 (28%). Elevated serum hsTnT concentrations were associated with chronic renal failure (p = 0.02) and diabetes (p < 0.0002). Pretreatment hsTnT was not elevated in the patient who developed fulminant irM. Pre-immunotherapy serum hsTnT concentrations were often asymptomatically elevated in patients with advanced skin cancer, none of whom subsequently developed irM during ICI therapy. However, large studies are required to assess the positive and negative predictive values of hsTnT for the development of irM. In the meantime, elevated hsTnT concentrations should be investigated before initiation of immunotherapy and closely monitored during early treatment cycles, where the risk of irM is greatest.
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Affiliation(s)
- Jonas K Kurzhals
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tobias Graf
- Department of Cardiology, University of Lübeck, Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ulrike Grzyska
- Department of Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany
| | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Ewan A Langan
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Dermatological Sciences, University of Manchester, Manchester, United Kingdom
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Sgouros D, Rigopoulos D, Panayiotides I, Apalla Z, Arvanitis DK, Theofili M, Theotokoglou S, Syrmali A, Theodoropoulos K, Pappa G, Damaskou V, Stratigos A, Katoulis A. Novel Insights for Patients with Multiple Basal Cell Carcinomas and Tumors at High-Risk for Recurrence: Risk Factors, Clinical Morphology, and Dermatoscopy. Cancers (Basel) 2021; 13:3208. [PMID: 34198960 PMCID: PMC8269292 DOI: 10.3390/cancers13133208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Basal cell carcinoma (BCC) quite frequently presents as multiple tumors in individual patients. Neoplasm's risk factors for local recurrence have a critical impact on therapeutic management. OBJECTIVE To detect risk factors for multiple BCCs (mBCC) in individual patients and to describe clinical and dermatoscopic features of low- and high-risk tumors. MATERIALS & METHODS Our study included 225 patients with 304 surgically excised primary BCCs. All patients' medical history and demographics were recorded. Clinical and dermatoscopic images of BCCs were evaluated for predefined criteria and statistical analyses were performed. RESULTS Grade II-III sunburns before adulthood (OR 2.146, p = 0.031) and a personal history of BCC (OR 3.403, p < 0.001) were the major predisposing factors for mBCC. Clinically obvious white color (OR 3.168, p < 0.001) and dermatoscopic detection of white shiny lines (OR 2.085, p = 0.025) represented strongly prognostic variables of high-risk BCC. Similarly, extensive clinico-dermatoscopic ulceration (up to 9.2-fold) and nodular morphology (3.6-fold) raise the possibility for high-risk BCC. On the contrary, dermatoscopic evidence of blue-black coloration had a negative prognostic value for high-risk neoplasms (light OR 0.269, p < 0.001/partial OR 0.198, p = 0.001). CONCLUSIONS Profiling of mBCC patients and a thorough knowledge of high-risk tumors' clinico-dermatoscopic morphology could provide physicians with important information towards prevention of this neoplasm.
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Affiliation(s)
- Dimitrios Sgouros
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (D.R.); (A.S.)
| | - Ioannis Panayiotides
- 2nd Department of Pathology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (I.P.); (V.D.)
| | - Zoe Apalla
- State Clinic of Dermatology, Hospital for Skin and Venereal Diseases, 54643 Thessaloniki, Greece;
| | - Dimitrios K. Arvanitis
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
| | - Melpomeni Theofili
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
| | - Sofia Theotokoglou
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
| | - Anna Syrmali
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
| | - Konstantinos Theodoropoulos
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
| | - Georgia Pappa
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
| | - Vasileia Damaskou
- 2nd Department of Pathology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (I.P.); (V.D.)
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (D.R.); (A.S.)
| | - Alexander Katoulis
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (M.T.); (S.T.); (A.S.); (K.T.); (G.P.); (A.K.)
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Alameda JP, García-García VA, López S, Hernando A, Page A, Navarro M, Moreno-Maldonado R, Paramio JM, Ramírez Á, García-Fernández RA, Casanova ML. CYLD Inhibits the Development of Skin Squamous Cell Tumors in Immunocompetent Mice. Int J Mol Sci 2021; 22:6736. [PMID: 34201751 PMCID: PMC8268443 DOI: 10.3390/ijms22136736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Cylindromatosis (CYLD) is a deubiquitinase (DUB) enzyme that was initially characterized as a tumor suppressor of adnexal skin tumors in patients with CYLD syndrome. Later, it was also shown that the expression of functionally inactive mutated forms of CYLD promoted tumor development and progression of non-melanoma skin cancer (NMSC). However, the ability of wild-type CYLD to inhibit skin tumorigenesis in vivo in immunocompetent mice has not been proved. Herein, we generated transgenic mice that express the wild type form of CYLD under the control of the keratin 5 (K5) promoter (K5-CYLDwt mice) and analyzed the skin properties of these transgenic mice by WB and immunohistochemistry, studied the survival and proliferating characteristics of primary keratinocytes, and performed chemical skin carcinogenesis experiments. As a result, we found a reduced activation of the nuclear factor kappa B (NF-κB) pathway in the skin of K5-CYLDwt mice in response to tumor necrosis factor-α (TNF-α); accordingly, when subjected to insults, K5-CYLDwt keratinocytes are prone to apoptosis and are protected from excessive hyperproliferation. Skin carcinogenesis assays showed inhibition of tumor development in K5-CYLDwt mice. As a mechanism of this tumor suppressor activity, we found that a moderate increase in CYLD expression levels reduced NF-κB activation, which favored the differentiation of tumor epidermal cells and inhibited its proliferation; moreover, it decreased tumor angiogenesis and inflammation. Altogether, our results suggest that increased levels of CYLD may be useful for anti-skin cancer therapy.
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Affiliation(s)
- Josefa P. Alameda
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Biomedical Research Institute I+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Verónica A. García-García
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Biomedical Research Institute I+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Silvia López
- Department of Animal Medicine and Surgery, Facultad de Veterinaria, UCM, 28040 Madrid, Spain; (S.L.); (R.A.G.-F.)
| | - Ana Hernando
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Bionomous Sàrl, PFL Innovation Park, Bâtiment, FCH-1015 Lausanne, Switzerland
| | - Angustias Page
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Biomedical Research Institute I+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Manuel Navarro
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Biomedical Research Institute I+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Rodolfo Moreno-Maldonado
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Bio-innova Consulting, 28049 Madrid, Spain
| | - Jesús M. Paramio
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Biomedical Research Institute I+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Ángel Ramírez
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Biomedical Research Institute I+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Rosa A. García-Fernández
- Department of Animal Medicine and Surgery, Facultad de Veterinaria, UCM, 28040 Madrid, Spain; (S.L.); (R.A.G.-F.)
| | - María Llanos Casanova
- Molecular and Translational Oncology Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), 28040 Madrid, Spain; (J.P.A.); (V.A.G.-G.); (A.H.); (A.P.); (M.N.); (R.M.-M.); (J.M.P.); (Á.R.)
- Biomedical Research Institute I+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
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Khalid A, van Essen P, Crittenden TA, Dean NR. The anatomical distribution of non-melanoma skin cancer: A retrospective cohort study of 22 303 Australian cases. ANZ J Surg 2021; 91:2750-2756. [PMID: 34152687 DOI: 10.1111/ans.17030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-melanoma skin cancers (NMSC) are the most common skin cancers worldwide with research establishing that ultraviolet (UV) radiation influences occurrence. However, recent studies about NMSC tumour frequencies suggested high NMSC predilections in low UV-exposed skin regions. METHODS The 'Human Surface Anatomy Labeling System' was used to define 100 skin regions to map NMSC locations excised at Flinders Medical Centre (FMC) between 1 January 2012 and 31 December 2017. Data were retrieved from the FMC histopathology database. A customised phrase algorithm was used to run a systematic word search on the dataset to quantify NMSC locations. RESULTS A total of 22 303 NMSC excisions were identified; 80% were head and neck excisions. Scalp, periocular and nasal regions showed a significantly greater predilection for basal cell carcinomas (BCC). Squamous cell carcinomas (SCC) had significantly more excisions in lip, neck and scalp regions. Regarding gender-related variations, more males had BCC excisions in ear regions and more females had nasal, lip, and ankle excisions. In SCC excisions, more males had scalp excisions and more females had leg and lip excisions. Considering age-related variation, significantly higher proportions of BCC were found with forehead excisions compared to scalp, neck and lower limb regions for SCC, all being highest for 60-79-year age groups. CONCLUSION The relationship between NMSC type and anatomical distribution may be partially explained by gender and age affecting NMSC predilections particularly in the head and neck. However, other skin regions could not be explained solely by these factors.
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Affiliation(s)
- Aafreen Khalid
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Phillipa van Essen
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Tamara A Crittenden
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicola R Dean
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
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Chouhan R, Patel R, Shakib K, Mitsimponas K. Surgical excision of non-melanoma skin cancer: no end in site? Br J Oral Maxillofac Surg 2021:S0266-4356(21)00209-6. [PMID: 34275678 DOI: 10.1016/j.bjoms.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/17/2021] [Indexed: 11/23/2022]
Abstract
Non-melanoma skin cancer (NMSC) is the most common type of cancer in the UK and Ireland, accounting for approximately 20% of all new malignancies recorded, with evidence of increasing incidence. Surgical excision is regarded as the gold standard treatment for such lesions; however, incomplete excision incurs both physical and financial strain on patients and the healthcare service. Our aim is to identify which anatomical regions of the head and neck pose greater risk of incomplete excision and raise awareness for future surgical practice. Manual data collection was carried out on all patients admitted to the OMFS department for surgical excision of NMSCs between January 2016 and December 2017. Information collected included clinical notes and MDT outcomes. NMSCs excised via Mohs surgery. All tumours incompletely excised and requiring further treatment were noted with particular emphasis on the site of the lesion within the head and neck region, and the location of the positive margin on the specimen itself. A total of 506 NMSCs were excised (307 BCC, 199 SCC). Of these, 7.8% (n=24) and 6.0% (n=12), respectively, required further treatment due to incomplete excision. The incompletely exised lesions were predominately located on the nose (13.3%), temple (15.0%), and ear (12.8%). Our results demonstrate that our department is successfully excising NMSCs with minimal cases requiring further management. This study has identified anatomical profiles posing a higher risk of incomplete removal. Alongside the conventionally challenging sites of the nose and ear, we have highlighted additional risk within the temporal region. We therefore propose that Mohs surgery or a two-stage procedure should be considered as management for the temple at future MDTs.
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Crisafulli S, Bertino L, Fontana A, Calapai F, Ingrasciotta Y, Berretta M, Trifirò G, Guarneri C. Incidence of Skin Cancer in Patients With Chronic Inflammatory Cutaneous Diseases on Targeted Therapies: A Systematic Review and Meta-Analysis of Observational Studies. Front Oncol 2021; 11:687432. [PMID: 34150655 PMCID: PMC8209509 DOI: 10.3389/fonc.2021.687432] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Cancer is one of the several comorbidities that have been linked with chronic cutaneous inflammatory diseases namely psoriasis/psoriatic arthritis and hidradenitis suppurativa. Although the chronic inflammatory state, typical of the diseases, may induce pro-tumorigenic effects, the debate whether or not the drugs currently used in clinical practice do in facts increase a patient's risk of malignancy remains largely unsolved. The therapeutic armamentarium has been greatly enhanced at least in the last two decades with the advent of biologics, a heterogeneous group of laboratory-engineered agents with more in the pipeline, and other targeted small molecules. Among the organ systems, skin results as one of the most commonly affected, non-melanoma skin cancers being the main drug-induced manifestations as side effect in course of these treatments. The objective of the study is to systematically review the cutaneous malignancy risk of the newer therapies through an overview of meta-analyses and observational studies on the topic.
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Affiliation(s)
- Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Lucrezia Bertino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Fabrizio Calapai
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, Section of Infectious Diseases, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Kyritsi A, Kikionis S, Tagka A, Koliarakis N, Evangelatou A, Papagiannis P, Stratigos A, Karalis V, Dallas P, Vitsos A, Ioannou E, Roussis V, Rallis M. Management of Acute Radiodermatitis in Non-Melanoma Skin Cancer Patients Using Electrospun Nanofibrous Patches Loaded with Pinus halepensis Bark Extract. Cancers (Basel) 2021; 13:2596. [PMID: 34073193 DOI: 10.3390/cancers13112596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary The most frequent adverse effect for patients receiving radiotherapy, an effective treatment for skin cancer when surgical removal of the tumor is impossible, is acute radiodermatitis, affecting patients’ physical function and often leading to therapy termination. Creams and other topical formulations used so far for the prevention of acute radiodermatitis are applied at regular intervals but do not ensure a constant and controlled transepidermal absorption. The aqueous extract of Aleppo pine bark, previously preclinically and clinically assessed in the form of gel, was herein loaded on micro/nanofibrous patches and clinically evaluated in comparison with a commercially used reference cream on non-melanoma skin carcinoma patients undergoing radiotherapy. The experimental patch significantly contributed to prophylaxis and successful management of acute radiodermatitis, safely restoring skin and its biophysical parameters to normal levels and reducing patients’ discomfort. Topical application of pine-loaded micro/nanofibrous patches holds great potential for the development of a new generation of anti-inflammatory skin care dressings against radiodermatitis. Abstract Acute radiodermatitis is the most common side effect in non-melanoma skin cancer patients undergoing radiotherapy. Nonetheless, despite the ongoing progress of clinical trials, no effective regimen has been found yet. In this study, a non-woven patch, comprised of electrospun polymeric micro/nanofibers loaded with an aqueous extract of Pinus halepensis bark (PHBE), was fabricated and clinically tested for its efficacy to prevent radiodermatitis. The bioactivity of the PHBE patch was evaluated in comparison with a medical cream indicated for acute radiodermatitis. Twelve volunteer patients were selected and randomly assigned to two groups, applying either the PHBE patch or the reference cream daily. Evaluation of radiation-induced skin reactions was performed during the radiotherapy period and 1 month afterwards according to the Radiation Therapy Oncology Group (RTOG) grading scale, photo-documentation, patient-reported outcomes (Visual Analog Scale, questionnaire), biophysical measurements (hydration, transepidermal water loss, erythema, melanin), and image analysis. In contrast with the reference product, the PHBE patch showed significant anti-inflammatory activity and restored most skin parameters to normal levels 1 month after completion of radiation therapy. No adverse event was reported, indicating that the application of the PHBE patch can be considered as a safe medical device for prophylactic radiodermatitis treatment.
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Zölzer F, Bauer S. Solar Ultraviolet Radiation Risk Estimates-A Comparison of Different Action Spectra and Detector Responsivities. Int J Environ Res Public Health 2021; 18:ijerph18094887. [PMID: 34064368 PMCID: PMC8125439 DOI: 10.3390/ijerph18094887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 02/02/2023]
Abstract
Studies assessing the dose–response relationship for human skin cancer induction by solar ultraviolet radiation (UVR) apply a range of methods to quantify relevant UVR doses, but information about the comparability of these datasets is scarce. We compared biologically weighted effectivities applying the most relevant UVR action spectra in order to test the ability of certain UVR detectors to mimic these biological effects at different times during the day and year. Our calculations were based on solar spectra measured at Dortmund, Germany (51.5° N) and at Townsville, Australia (19.3° S), or computed for latitudes 20° S and 50° N. Convolutions with the CIE action spectra for erythema and non-melanoma skin cancer (NMSC) and with ICNIRP’s weighting function showed comparable solar zenith angle (SZA) dependences with little influence of season or latitude. A different SZA dependence was found with Setlow’s action spectrum for melanoma induction. Calculations for a number of UVR detector responsivities gave widely discrepant absolute irradiances and doses, which were nevertheless related to those calculated with both CIE spectra by correction factors largely independent of the SZA. Commonly used detectors can thus provide quite accurate estimates of NMSC induction by solar UVR, whereas they may be inadequate to mimic melanoma induction.
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Affiliation(s)
- Friedo Zölzer
- Institute of Radiology, Toxicology, and Civil Protection, Faculty of Health and Social Sciences, University of South Bohemia, 37011 Ceske Budejovice, Czech Republic
- Correspondence: ; Tel.: +420-389-037-507
| | - Stefan Bauer
- Federal Institute for Occupational Safety and Health (BAuA), 44149 Dortmund, Germany;
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Roy E, Wong HY, Villani R, Rouille T, Salik B, Sim SL, Murigneux V, Stark MS, Fink JL, Soyer HP, Walker G, Lyons JG, Saunders N, Khosrotehrani K. Regional Variation in Epidermal Susceptibility to UV-Induced Carcinogenesis Reflects Proliferative Activity of Epidermal Progenitors. Cell Rep 2021; 31:107702. [PMID: 32492418 DOI: 10.1016/j.celrep.2020.107702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
To better understand the influence of ultraviolet (UV) irradiation on the initial steps of skin carcinogenesis, we examine patches of labeled keratinocytes as a proxy for clones in the interfollicular epidermis (IFE) and measure their size variation upon UVB irradiation. Multicolor lineage tracing reveals that in chronically irradiated skin, patches near hair follicles (HFs) increase in size, whereas those far from follicles do not change. This is explained by proliferation of basal epidermal cells within 60 μm of HF openings. Upon interruption of UVB, patch size near HFs regresses significantly. These anatomical differences in proliferative behavior have significant consequences for the cell of origin of basal cell carcinomas (BCCs). Indeed, a UV-inducible murine BCC model shows that BCC patches are more frequent, larger, and more invasive near HFs. These findings have major implications for the prevention of field cancerization in the epidermis.
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Affiliation(s)
- Edwige Roy
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Ho Yi Wong
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Rehan Villani
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Thomas Rouille
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Basit Salik
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Seen Ling Sim
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Valentine Murigneux
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Mitchell S Stark
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD 4102, Australia
| | - J Lynn Fink
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia; The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD 4102, Australia
| | - Graeme Walker
- QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
| | - J Guy Lyons
- Discipline of Dermatology, Bosch Institute, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Nicholas Saunders
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Kiarash Khosrotehrani
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia; UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia.
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Mercurio L, Albanesi C, Madonna S. Recent Updates on the Involvement of PI3K/AKT/mTOR Molecular Cascade in the Pathogenesis of Hyperproliferative Skin Disorders. Front Med (Lausanne) 2021; 8:665647. [PMID: 33996865 PMCID: PMC8119789 DOI: 10.3389/fmed.2021.665647] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
PhosphoInositide-3 Kinase (PI3K) represents a family of different classes of kinases which control multiple biological processes in mammalian cells, such as cell growth, proliferation, and survival. Class IA PI3Ks, the main regulators of proliferative signals, consists of a catalytic subunit (α, β, δ) that binds p85 regulatory subunit and mediates activation of AKT and mammalian Target Of Rapamycin (mTOR) pathways and regulation of downstream effectors. Dysregulation of PI3K/AKT/mTOR pathway in skin contributes to several pathological conditions characterized by uncontrolled proliferation, including skin cancers, psoriasis, and atopic dermatitis (AD). Among cutaneous cancers, basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) display PI3K/AKT/mTOR signaling hyperactivation, implicated in hyperproliferation, and tumorigenesis, as well as in resistance to apoptosis. Upregulation of mTOR signaling proteins has also been reported in psoriasis, in association with enhanced proliferation, defective keratinocyte differentiation, senescence-like growth arrest, and resistance to apoptosis, accounting for major parts of the overall disease phenotypes. On the contrary, PI3K/AKT/mTOR role in AD is less characterized, even though recent evidence demonstrates the relevant function for mTOR pathway in the regulation of epidermal barrier formation and stratification. In this review, we provide the most recent updates on the role and function of PI3K/AKT/mTOR molecular axis in the pathogenesis of different hyperproliferative skin disorders, and highlights on the current status of preclinical and clinical studies on PI3K-targeted therapies.
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Affiliation(s)
- Laura Mercurio
- Laboratory of Experimental Immunology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Cristina Albanesi
- Laboratory of Experimental Immunology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Stefania Madonna
- Laboratory of Experimental Immunology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
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Sakaki JR, Melough MM, Roberts MB, Eaton CB, Shadyab AH, Qureshi AA, Chun OK, Cho E. Citrus Consumption and the Risk of Non-Melanoma Skin Cancer in the Women's Health Initiative. Cancers (Basel) 2021; 13:2173. [PMID: 33946526 DOI: 10.3390/cancers13092173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Citrus products are rich in furocoumarins, which can increase the risk of incident non-melanoma skin cancer (NMSC) when combined with ultraviolet radiation. However, few observational studies have evaluated the link between citrus intake and NMSC incidence. The aim of this study was to determine whether citrus intake was related to the NMSC incidence in participants of the Women’s Health Initiative Observational Study. The results of this study indicated that high citrus juice consumption was associated with a higher risk of incident NMSC compared to low consumption. These findings add further evidence of the potentially carcinogenic nature of certain citrus products and highlight the need to continue investigations in identifying risk factors and mechanisms. Abstract Evidence from animal studies suggests that furocoumarins, compounds present in citrus products, can increase the risk of non-melanoma skin cancer (NMSC) when combined with ultraviolet radiation. The objective of this study was to determine the relationship between citrus intake and NMSC risk among postmenopausal women from the Women’s Health Initiative (WHI) Observational Study, who were aged 50–79 years at enrollment (1993–1998). The consumption of citrus fruit, citrus juice, and non-citrus fruit and juice were measured at the baseline of the study using a food frequency questionnaire (FFQ). NMSC cases (basal or squamous cell carcinomas) were self-reported during annual follow-up surveys. The outcome data used for this analysis were collected through March 2020. The relative risk (RR) for incident NMSC by citrus consumption was calculated. Among 49,007 non-Hispanic white participants, there were 8642 cases of incident NMSC. Using less than one serving of citrus juice per week as reference, the RRs and 95% confidence intervals (CI) for incident NMSC by citrus juice intake were 1.03 (0.95, 1.10) for one serving/week, 1.06 (1.00, 1.12) for two to four servings/week, 0.98 (0.90, 1.07) for five to six servings/week, and 1.08 (1.02, 1.13) for one or more serving/day (p-trend = 0.007). Subgroup analyses did not reveal meaningful associations by sun exposure variables. In conclusion, there were indications of a slightly higher risk of incident NMSC among citrus juice consumers; however, further longitudinal and mechanistic studies are needed to confirm the key risk factors.
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Pogorzelska-Dyrbus J, Szepietowski JC. Adhesion Molecules in Non-melanoma Skin Cancers: A Comprehensive Review. In Vivo 2021; 35:1327-1336. [PMID: 33910810 DOI: 10.21873/invivo.12385] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 12/18/2022]
Abstract
Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most frequently diagnosed cancers, generating significant medical and financial problems. Cutaneous carcinogenesis is a very complex process characterized by genetic and molecular alterations, and mediated by various proteins and pathways. Cell adhesion molecules (CAMs) are transmembrane proteins responsible for cell-to-cell and cell-to-extracellular matrix adhesion, engaged in all steps of tumor progression. Based on their structures they are divided into five major groups: cadherins, integrins, selectins, immunoglobulins and CD44 family. Cadherins, integrins and CD44 are the most studied in the context of non-melanoma skin cancers. The differences in expression of adhesion molecules may be related to the invasiveness of these tumors, through the loss of tissue integrity, neovascularization and alterations in intercellular signaling processes. In this article, each group of CAMs is briefly described and the present knowledge on their role in the development of non-melanoma skin cancers is summarized.
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Affiliation(s)
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Ciążyńska M, Olejniczak-Staruch I, Sobolewska-Sztychny D, Narbutt J, Skibińska M, Lesiak A. Ultraviolet Radiation and Chronic Inflammation-Molecules and Mechanisms Involved in Skin Carcinogenesis: A Narrative Review. Life (Basel) 2021; 11:326. [PMID: 33917793 DOI: 10.3390/life11040326] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022] Open
Abstract
The process of skin carcinogenesis is still not fully understood. Both experimental and epidemiological evidence indicate that chronic inflammation is one of the hallmarks of microenvironmental-agent-mediated skin cancers and contributes to its development. Maintaining an inflammatory microenvironment is a condition leading to tumor formation. Multiple studies focus on the molecular pathways activating tumorigenesis by inflammation and indicate several biomarkers and factors that can improve diagnostic and prognostic processes in oncology and dermatology. Reactive oxygen species produced by ultraviolet radiation, oxidizers, or metabolic processes can damage cells and initiate pro-inflammatory cascades. Considering the potential role of inflammation in cancer development and metastasis, the identification of early mechanisms involved in carcinogenesis is crucial for clinical practice and scientific research. Moreover, it could lead to the progress of advanced skin cancer therapies. We focus on a comprehensive analysis of available evidence and on understanding how chronic inflammation and ultraviolet radiation can result in skin carcinogenesis. We present the inflammatory environment as complex molecular networks triggering tumorigenesis and constituting therapeutic targets.
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Laliscia C, Fuentes T, Coccia N, Mattioni R, Perrone F, Paiar F. High-dose-rate brachytherapy for non-melanoma skin cancer using tailored custom moulds - a single-centre experience. Contemp Oncol (Pozn) 2021; 25:12-16. [PMID: 33911976 PMCID: PMC8063903 DOI: 10.5114/wo.2021.104688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY The aim of this retrospective study was to analyse tumour control, toxicity, and aesthetic outcome of patients affected by non-melanoma skin cancer (NMSC) treated with 192 Ir high-dose-rate (HDR)-brachytherapy (BT) at the Division of Radiotherapy, University of Pisa. MATERIAL AND METHODS From January 2014 to December 2019 we treated 37 patients (median age 79 years; range 31-91 years) affected by NMSC, with the following histological subtypes: 62.2% basal cell carcinoma and 37.8% squamous cell carcinoma. We analysed 40 lesions with a depth ≤ 5 mm, located in 40.0% scalp, 17.5% nose, 25.0% face, and 17.5% ear, all treated with 192 Ir-based HDR-BT, using tailored custom moulds, with a median of 5 catheters (range, 1-9) spaced 1 cm apart. The most common fractionation scheme was 40 Gy in 8 daily fractions; the biological effective dose was 60 Gy. RESULTS The median follow-up was 25 months (range, 3-70 months). The 2-year local control rate was 90%. Common terminology criteria for adverse event (CTCAE vs. 5.0) G1 toxicities were dermatitis (52%), pain (25%), and ulceration (22%). The only G2 acute toxicities were dermatitis and ulceration. The most common G1 late toxicities were fibrosis (17%), atrophy (15%), and hypopigmentation (12%). No G3 or higher acute or late toxicity was reported. Excellent cosmetic results were observed in 65.0% of the lesions; only 1 case (2.5%) reported a poor cosmetic result. CONCLUSIONS Surface mould HDR-BT is a safe, effective, and well tolerated treatment modality for NMSC and can be considered a good alternative, especially for elderly patients who are often unfit for surgery.
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Affiliation(s)
| | - Taiusha Fuentes
- Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Natalina Coccia
- Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | | | | | - Fabiola Paiar
- Division of Radiation Oncology, University of Pisa, Pisa, Italy
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Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Protection Against Solar Ultraviolet Radiation in Outdoor Construction Workers: Study Protocol for a Non-randomized Controlled Intervention Study. Front Public Health 2021; 9:602933. [PMID: 33748058 PMCID: PMC7969508 DOI: 10.3389/fpubh.2021.602933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/10/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction: Non-melanoma skin cancer (NMSC) incidence is increasing, and occupational solar exposure contributes greatly to the overall lifetime ultraviolet radiation (UVR) dose. This is reflected in an excess risk of NMSC showing up to three-fold increase in outdoor workers. Risk of NMSC can be reduced if appropriate measures to reduce UVR-exposure are taken. Regular use of sunscreens showed reduced risk of NMSC. However, sun-safety behavior in outdoor workers is poor. The objective of this study is to investigate the effectiveness of an intervention aiming at increasing sunscreen use by construction workers. Methods: This non-randomized controlled intervention study is comprised of two intervention and two control groups recruited at four different construction sites in the Netherlands. The study population comprises ~200 construction workers, aged 18 years or older, followed during 12 weeks. The intervention consists of providing dispensers with sunscreens (SPF 50+) at construction sites and regular feedback on the application achieved by continuous electronic monitoring. All groups will receive basic information on UV-exposure and skin protection. Stratum corneum (SC) samples will be collected for measurement of biomarkers to assess internal UV-dose. External UV-dose will be assessed by personal UV-sensors worn by the workers during work-shifts in both groups. To detect presence of actinic keratosis (AK) or NMSC, a skin check of body parts exposed to the sun will be performed at the end of the study. The effect of the intervention will be assessed from data on self-reported sunscreen use by means of questionnaires collected on baseline and after 12 weeks of intervention (primary outcome). Levels of SC biomarkers of internal UV-dose, external UV-dose, number of sunburn episodes, and prevalence of NMSC including AK will be assessed as secondary outcomes. The electronically monitored sunscreen consumption will be assessed as process outcome. Discussion: This study is intended to provide evidence of the effectiveness of a technology-driven intervention to increase sunscreen use in outdoor construction workers. Furthermore, it will increase insight in the UV-protective behavior, external and internal UV-exposure, and the prevalence of NMSC, including AK, in construction workers. Trial Registration: The Netherlands Trial Register (NTR): NL8462 Registered on March 19, 2020.
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Affiliation(s)
- Anne J Keurentjes
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sanja Kezic
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Carel T J Hulshof
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Cammarata E, Zavattaro E, Astolfi S, Airoldi C, Giorgione R, Boggio P, Savoia P. Purse-string suture versus full-thickness skin graft: An efficacy and safety comparison study. Dermatol Ther 2021; 34:e14909. [PMID: 33619872 DOI: 10.1111/dth.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Purse-string suture (PSS) and full-thickness skin graft (FTSG) are two different approaches to the closure of circular skin defects. In this study, we compare the feasibility and the aesthetic outcome of these two techniques in high operatory risk non-melanoma skin cancer (NMSC) patients. We performed a retrospective study on 65 patients, treated with PSS or FTSG, and evaluated after a minimum follow-up of 6 months. The post-surgery assessment was based on the Vancouver scar scale (VSS) and differences in terms of defect areas, operative and healing times were performed both with parametric and nonparametric tests. Operative times in PSS were significantly lower than those needed for FTSG, without perioperative adverse events; PSS required a waiting time before removing the suture greater than FTSG. After surgery, PSS resulted in a median defect area reduction of 73%. No significant differences were found in the median value for VSS in the two groups. Based on our clinical experience, the PSS advantages in terms of feasibility, rapidity of execution, and mean defect area reduction were confirmed. So, this technique seems to be appropriate for fragile patients affected by NMSC, that cannot hold long surgical sessions.
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Affiliation(s)
- Edoardo Cammarata
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Elisa Zavattaro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Paolo Boggio
- Dermatology Unit, AOU Maggiore della Carità, Novara, Italy
| | - Paola Savoia
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
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Fania L, Ricci F, Paradisi A, Palese E, Di Lella G, Iemboli ML, Mazzanti C, Pallotta S, Panebianco A, Lembo L, Candi E, Dellambra E, Abeni D. Scarce knowledge of systemic photoprotection among skin cancer patients: a cross-sectional survey. Eur J Dermatol 2021:ejd.2020.3918. [PMID: 33586658 DOI: 10.1684/ejd.2020.3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of both melanoma and non-melanoma skin cancers (NMSC) is increasing worldwide and these tumours have become an important health issue. Topical and systemic photoprotection are the cornerstone to decrease the incidence of these tumours. OBJECTIVES The aim of this study was to collect information about the knowledge of patients with a history of NMSC or melanoma regarding systemic photoprotection. MATERIALS & METHODS This study was based on a multicentre survey. Standardized, self-administered questionnaires were collected from September 2019 to December 2019 in NMSC and melanoma units, as well as the general dermatology outpatient clinic for the control group. RESULTS A total of 375 patients were enrolled in two Italian centres. The level of knowledge regarding systemic photoprotection was relatively scarce and was greater in: female patients; patients with normal weight and lighter hair, eye color and skin phototype; patients with a higher educational level; patients with non-cancerous skin conditions; and those who used sunscreens more frequently. CONCLUSIONS A very low level of knowledge of systemic photoprotection was identified among skin cancer patients.
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Affiliation(s)
- Luca Fania
- First Dermatology Unit, Istituto Dermopatico dell'Immacolata - IRCCS
| | | | - Andrea Paradisi
- Dermatology Unit, "Cristo Re" General Hospital,, Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata - IRCCS
| | - Enzo Palese
- Dermatologic Surgery and Laser Therapy Unit, Istituto Dermopatico dell'Immacolata - IRCCS
| | - Giovanni Di Lella
- Day Surgery Unit, Fifth Dermatology Unit, Istituto Dermopatico dell'Immacolata - IRCCS
| | | | - Cinzia Mazzanti
- First Dermatology Unit, Istituto Dermopatico dell'Immacolata - IRCCS
| | - Sabatino Pallotta
- Day Surgery Unit, Fifth Dermatology Unit, Istituto Dermopatico dell'Immacolata - IRCCS
| | | | - Luigi Lembo
- Day Surgery Unit, Fifth Dermatology Unit, Istituto Dermopatico dell'Immacolata - IRCCS
| | - Eleonora Candi
- Department of Experimental Medicine, University of Rome Tor Vergata,, Biochemistry Laboratory, Istituto Dermopatico dell'Immacolata - IRCCS
| | - Elena Dellambra
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata - IRCCS, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata - IRCCS
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Fania L, Didona D, Di Pietro FR, Verkhovskaia S, Morese R, Paolino G, Donati M, Ricci F, Coco V, Ricci F, Candi E, Abeni D, Dellambra E. Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2021; 9:171. [PMID: 33572373 DOI: 10.3390/biomedicines9020171] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC), a non-melanoma skin cancer, is a keratinocyte carcinoma representing one of the most common cancers with an increasing incidence. cSCC could be in situ (e.g., Bowen’s disease) or an invasive form. A significant cSCC risk factor is advanced age, together with cumulative sun exposure, fair skin, prolonged immunosuppression, and previous skin cancer diagnoses. Although most cSCCs can be treated by surgery, a fraction of them recur and metastasize, leading to death. cSCC could arise de novo or be the result of a progression of the actinic keratosis, an in situ carcinoma. The multistage process of cSCC development and progression is characterized by mutations in the genes involved in epidermal homeostasis and by several alterations, such as epigenetic modifications, viral infections, or microenvironmental changes. Thus, cSCC development is a gradual process with several histological- and pathological-defined stages. Dermoscopy and reflectance confocal microscopy enhanced the diagnostic accuracy of cSCC. Surgical excision is the first-line treatment for invasive cSCC. Moreover, radiotherapy may be considered as a primary treatment in patients not candidates for surgery. Extensive studies of cSCC pathogenic mechanisms identified several pharmaceutical targets and allowed the development of new systemic therapies, including immunotherapy with immune checkpoint inhibitors, such as Cemiplimab, and epidermal growth factor receptor inhibitors for metastatic and locally advanced cSCC. Furthermore, the implementation of prevention measures has been useful in patient management.
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Abstract
Background Porokeratosis (PK) is a rare group of keratinization disorders. While the overall prognosis of PK is favorable, malignant transformation of PK to skin cancer has been reported in 6.9% to 11.6% of the cases. Prior estimates of malignant transformation of PK have been based on reviews of published cases, which introduces possible publication bias. We aim to eliminate this potential bias and quantify the characteristics, risk factors, and malignancy potential of PK. Methodology A single-center retrospective chart review of patients with a diagnosis of PK was conducted. Results In this study, 6.4% to 16.4% of histologically confirmed PK lesions demonstrated malignant transformation. A higher proportion of disseminated superficial actinic porokeratosis (DSAP) cases (as high as 29.3%) showed malignant transformation compared to PK of Mibelli (as high as 6.0%). Out of the two cases of linear PK, both demonstrated malignant transformation. Conclusions In summary, PKs are at risk for malignant transformation, and patients with DSAP and linear PK, in particular, should receive more long-term surveillance. Limitations of this study include the inability to control for confounding factors due to the retrospective nature and the small size of our cohort.
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Affiliation(s)
| | - Mio Nakamura
- Dermatology, University of Michigan, Ann Arbor, USA
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Abstract
This article reviews the 2020 European Society for Photodynamic Therapy (Euro-PDT) Annual Congress. Cutting edge studies included assessment of immunohistochemical variables influencing response of basal cell carcinomas and Bowen's disease to PDT with p53, the only biomarker associated with good response in both conditions. A further study indicated that analysis of molecular markers, such as PIK3R1, could help select patients with actinic keratoses who demonstrate the best response to daylight PDT. Novel delivery protocols include artificial daylight, and laser-assisted and textile PDT. The meeting learnt of novel indications including antimicrobial PDT, as well as methods to optimise daylight PDT, including combination therapy for actinic keratoses. Adverse events were reviewed and options for painless and efficient PDT assessed, including the effect of reduced drug-light interval. A smartphone application was also evaluated which may be used to assist clinicians and patients in effective dosing and timing of daylight PDT via computational algorithms using data from earth observation satellites, to send light and ultraviolet dose information directly to patients' smart phones.
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Borik-Heil L, Geroldinger A, Dunkler D, Geusau A. The spectrum of skin diseases in four different types of organ-transplant recipients: a comparative single-centre cohort study. Eur J Dermatol 2021; 31:65-74. [PMID: 33648926 DOI: 10.1684/ejd.2021.3967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Organ transplant recipients (OTR) are at marked increased risk of skin cancer and skin infections compared to the general population. OBJECTIVES The purpose of this study was to acquire long-term incidence data on commonly occurring skin diseases in four different transplant groups. MATERIALS & METHODS This retrospective single-centre cohort study included 621 OTR. By counting defined malignant, inflammatory, infectious or drug-related skin conditions per patient and visit, incidence rates (IR) for the different groups of OTR were calculated as cases per 1000-patient years and cumulative incidences of non-melanoma skin cancer (NMSC), respectively. RESULTS Overall, 2,309 non-malignant skin conditions and 340 NMSC were registered. Skin infections were most common (51.4%), followed by inflammatory skin conditions (35.6%) and sun-induced skin damage (32.9%). Kidney transplant recipients (KTR) had a 4.7-fold (95% CI: 2.7-8.0; p < 0.0001), 2.6-fold (95% CI: 1.2-5.3; p = 0.0098) and 5.4-fold (95% CI: 2.8-10.3; - < 0.0001) higher IR for oral candidiasis, oral aphthosis and herpes simplex virus infections, respectively, compared to the other OTR. Pruritus was most commonly reported in liver transplant recipients (95% CI: 1.3-5.3; p = 0.0047). KTR and lung transplant recipients (LuTR) had a 10.7-fold (95% CI:3.6-43.2; p < 0.0001) higher IR of steroid induced acne. KTR had a 1.6-fold (95% CI: 1.1-2.3; p = 0.0096) higher IR of squamous cell carcinoma compared to the other groups. The incidence of basal cell carcinoma was 2.5-fold higher (95% CI: 1.7-3.6; p < 0.0001) in LuTR, compared to the other OTR. CONCLUSION This study provides additional organ-specific incidence data on non-malignant skin diseases and skin cancer in OTR.
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Arisi M, Manganoni AM, de Palma G, Magoni M, Donato F, Scarcella C, Orizio G, Pavoni L, Moggio E, Venturini M, Rossi M, Tomasi C, Calzavara-Pinton PG. Neoplastic and inflammatory skin disorders and serum levels of polychlorinated biphenyls in a population living in a highly polluted area. Eur J Dermatol 2021; 31:41-7. [PMID: 33586660 DOI: 10.1684/ejd.2021.3966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although polychlorinated biphenyls (PCBs) have been classified as human carcinogens for their association with melanoma, few data are available for other skin lesions. OBJECTIVES To investigate the prevalence of skin disorders in a highly PCB polluted area in northern Italy, with locally produced food as the main source of human contamination, and evaluate the association between skin lesions and PCB serum levels, taking account of possible confounders. MATERIALS & METHODS Thirty-three PCB congeners were quantitatively assessed and a total of 189 subjects were equally divided into three groups using the tertiles of total PCB serum concentrations. All subjects underwent a clinical examination and were interviewed on their risk factors and history of skin diseases. RESULTS No statistically significant difference was found in the prevalence of skin cancer, nevi, pigmentary disorders as well as inflammatory and infectious skin diseases among the three PCB exposure groups. It should be noted that the use of questionnaires to assess subjects' past sun exposure and photoprotection is intrinsically flawed due to random error. CONCLUSION Our study does not support the hypothesis that chronic PCB exposure, through the ingestion of contaminated food, determines an increased risk of developing skin diseases.
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Surmanowicz P, Sivanand A, Du AX, Mahmood MN, Gniadecki R. Muffin Technique Micrographic Surgery for Non-melanoma Skin Cancer. Front Med (Lausanne) 2021; 7:637223. [PMID: 33553223 PMCID: PMC7859636 DOI: 10.3389/fmed.2020.637223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/29/2020] [Indexed: 01/31/2023] Open
Abstract
Background: Mohs micrographic surgery (MMS) is the gold standard treatment for high-risk facial non-melanoma skin cancer. However, patients' access to MMS is limited by cost. The muffin technique micrographic surgery (MTMS) is an alternative micrographic technique wherein the entire excised margin is evaluated post-operatively by a pathologist using paraffin-embedded material. Herein, we describe the implementation and the preliminary results of MTMS in an academic dermatology center. Objective: To describe the MTMS and outline its efficacy and safety in a real-world clinical academic setting. Methods: A retrospective chart review was conducted of all patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) who underwent MTMS at the University of Alberta Dermatology Center from June 2016 until July 2019. Results: A total of 69 patients were included (64 BCCs and 5 SCCs). 68.1% of surgeries had clear margins following the first incision, 100% after second round re-excisions. There were no observed cases of tumor recurrence after a median 40 months of follow-up. There were no major adverse events or complications. Conclusions: MTMS is a superior alternative to simple excision of skin cancer by providing full margin control and residual tumor mapping.
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Affiliation(s)
- Philip Surmanowicz
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Arunima Sivanand
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amy X Du
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Muhammad N Mahmood
- Department of Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Gniadecki
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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135
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Madaan P, Sikka P, Malik DS. Cosmeceutical Aptitudes of Niacinamide: A Review. Recent Adv Antiinfect Drug Discov 2021; 16:196-208. [PMID: 34844552 DOI: 10.2174/2772434416666211129105629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/06/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The prevalence and scope of dermatological illness differ from region to region. Based upon type and severity, the conditions may vary from superficial to deep systemic skin infections. Niacinamide, an amide analog of vitamin B3 which was conventionally utilized as a food supplement, is now explored for the management of skin disorders. Being a powerhouse on its own, it is not stored inside the body naturally and has to be acquired from external sources. Areas Covered: This review is an attempt to disclose the physiology, pharmacology, and highlight the dermatological potentials of niacinamide, discussing its pharmacological mechanisms, varied commercially available treatments, and novel approaches, i.e., in research and patented formulations. RESULTS Niacinamide has been verified in treating almost every skin disorder, viz. aging, hyperpigmentation, acne, psoriasis, pruritus, dermatitis, fungal infections, epidermal melasma, non-melanoma skin cancer, etc. It has been reported to possess numerous properties, for instance, anti-inflammatory, antimicrobial, antioxidant, antipruritic, and anticancer, which makes it an ideal ingredient for varied dermal therapies. Long term use of niacinamide, regardless of the skin type, paves the way for new skin cells, making skin healthier, brighter, and hydrated. CONCLUSION Niacinamide possesses a variety of positive characteristics in the field of dermatology. Novel approaches are warranted over current treatments which could bypass the above shortcomings and form an effective and stable system. Hence, niacinamide has the potential to become an individual and a productive component with wide future scope.
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Affiliation(s)
- Piyush Madaan
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab,India
| | - Priyanshi Sikka
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab,India
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136
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Pellizzon ACA, Fogaroli R, Chen MJ, Maia P, Gondim G, Guedes DC, Ramos H, Silva MLG. High-dose-rate brachytherapy using Leipzig applicators for non-melanoma localized skin cancer. J Contemp Brachytherapy 2020; 12:435-40. [PMID: 33299432 DOI: 10.5114/jcb.2020.100376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Technological advances with commercial production of surface applicators allowed high-dose-rate (HDR) afterloading brachytherapy to overpass challenges associated with the delivery of superficial radiation when treating non-melanoma skin cancer (NMSC). We reviewed our single institutional experience using HDR to treat basal (BCC) and squamous cell (SCC) carcinomas. Material and methods A retrospective review of all patients treated with HDR and Leipzig-style applicators for NMSC at the Radiation Oncology Department, AC Camargo Cancer Center, from March 2013 to December 2018 was performed. Results Seventy-one patients with 101 lesions (BCCs, 69.3% or n = 70) and median age 80 (range, 51-102) years old were evaluated. The median follow-up was 42.8 (range, 12-82) months. The 3-year and 5-year actuarial local control (LC) rates were 97.9% and 87.2%, respectively. On univariate analysis, treatments with EQD2 less than 50 Gy (p < 0.001) and dose per fraction smaller than 3 Gy (p < 0.001) were found to be statistically significant predictive factors of a worse outcome. On multivariate analysis, SCC had a worse prognosis over BCC (p = 0.007, HR = 2.3, CI: 1.2-6.6). All patients developed some degree of acute side effects graded 1 to 2. Grade 3 acute side effects were observed in 9 (8.9%) patients. Moreover, severe late side effects (grade 3), hypopigmentation, and telangiectasia were observed in 4 (3.9%) patients. No grade 4 acute or late side effects were seen in this cohort. Conclusions HDR offers a convenient treatment schedule for patients and is associated with excellent LC. The most effective regimen, in terms of dose and fractionation, to treat superficial NMSC with HDR remains uncertain, but a moderate minimum EQD2 dose of 50 Gy should be used.
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137
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Modonese A, Gobba F. [Occupational risk related to natural optical radiation exposure and skin cancers]. G Ital Med Lav Ergon 2020; 42:329-331. [PMID: 33600663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Skin tumors are the most frequent neoplasms worldwide in Caucasian subjects, and UV exposure is one of the most relevant risk factors in their etiology. Cumulative UV exposure is strongly associated with an increased occurrence of both basal and squamous cell carcinomas (i.e. Non melanoma skin cancers - NMSC), while for malignant melanoma the role of UV radiation as risk factors seems more related to intermittent and intense exposures, able to induce repeated sunburns, at young ages. Considering the occupational risk, currently UV radiation, part of the solar radiation (SR) spectrum, is one of the major risks in all jobs including outdoor activities (outdoor work - OW): many studies show high levels of solar UV exposure during OW, nevertheless to date the European, and Italian, legislation on occupational risks prevention does not include specific requirements for SR compleexposure at work, as occupational exposure limits values or workers' health surveillance. This is not coherent with the strong associations showed in scientific literature in particular between the occurrence of NMSC and a history of OW. Accordingly, considering the high exposure levels, the large number of outdoor workers and the strong associations with NMSC, we'd expect a relevant number of occupational skin cancers (OSC) to be reported every year to the national workers' compensation authorities in European countries. Nevertheless, in Italy, as in other European countries, the number of reported UV-induced OSC is much lower than the expected number of OSC, with less than 40 cases reported on average in Italy in last years compared to about a thousand of expected cases incident in outdoor workers per year. An increasing in the reporting of OSC would certainly be important, for the purpose of a better recognition of the real dimension of the phenomenon, and to stimulate the implementation of adequate preventive strategies, in order to guarantee an improved protection of outdoor workers and a more appropriate prevention of the adverse health effects related to solar UV exposure.
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Affiliation(s)
- Alberto Modonese
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia
| | - Fabriziomaria Gobba
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia
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138
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Mufti A, Maliyar K, Sachdeva M, Cyr J, Doiron P, Dahlke E. Full Body Skin Examination Practices Among Canadian Dermatologists: Results of a Nationwide Survey. J Cutan Med Surg 2020; 25:212-215. [PMID: 33242985 DOI: 10.1177/1203475420974648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Asfandyar Mufti
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada
| | | | | | - Janelle Cyr
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada
| | - Philip Doiron
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada
| | - Erin Dahlke
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada.,10070 Mohs Micrographic Surgery Clinic, Medical Education Teaching Clinic, St. Joseph's Health Centre Toronto, Canada
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139
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John SM, Garbe C, French LE, Takala J, Yared W, Cardone A, Gehring R, Spahn A, Stratigos A. Improved protection of outdoor workers from solar ultraviolet radiation: position statement. J Eur Acad Dermatol Venereol 2020; 35:1278-1284. [PMID: 33222341 DOI: 10.1111/jdv.17011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022]
Abstract
The vast majority of non-melanoma skin cancer (NMSC) is attributable to excessive exposure to ultraviolet radiation (UVR). Outdoor workers are exposed to an UVR dose at least 2 to 3 times higher than indoor workers and often to daily UVR doses 5 times above internationally recommended limits. The risk of UVR workplace exposure is vastly neglected, and the evident future challenges presented in this statement are contrasted with the current situation regarding legal recognition, patient care and compensation. While prevention is crucial to reduce cancer risks for outdoor workers, it is as much of relevance to better protect them through legally binding rules and regulations. Specific actions are outlined in five recommendations based on a Call to Action (table 1). The role of health professionals, including dermatologists, in this context is crucial.
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Affiliation(s)
- S M John
- EADV Task Force Occupational Skin Diseases and Dept. Dermatology, Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany
| | - C Garbe
- European Association of Dermato Oncology (EADO) and Department of Dermatology, Eber, hard Karls University, Tübingen, Germany
| | - L E French
- International League of Dermatological Societies (ILDS) and Department of Dermatology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - J Takala
- International Commission on Occupational Health (ICOH), University of Tampere, Tampere, Finland
| | - W Yared
- European Cancer Leagues (ECL), Brussels, Belgium
| | - A Cardone
- European Cancer Patient Coalition (ECPC), Brussels, Belgium
| | - R Gehring
- Safety and Health, European Federation Building and Woodworkers (EFBWW), Brussels, Belgium
| | - A Spahn
- Agriculture Section, European Federation of Food, Agriculture and Tourism Trade Unions (EFFAT), Brussels, Belgium
| | - A Stratigos
- European Academy of Dermatology and Venereology (EADV) and Dept. Dermatology, National and Kapodistrian University of Athens, Athens, Greece
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140
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Nightingale J, Travers L, Campbell J, Huang J, Green M, Warren T, Fitzgerald G. Outpatient surgical management of non-melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes. ANZ J Surg 2020; 91:139-144. [PMID: 33205533 DOI: 10.1111/ans.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-melanoma skin cancer is the most commonly diagnosed malignancy in Australia. Lesions of the head and neck are often outside the scope of primary care providers. The challenges of cancer care in regional Australia necessitate careful resource planning. This study presents an outpatient model that minimizes health service cost with local general practitioner follow-up. METHODS A retrospective review of 105 patients with 122 skin lesions in a dedicated Facial Lesion Assessment Management and Excision clinic was performed from July 2018 to 2019. Clinical outcomes, patient travel and cost analysis/comparison were recorded. RESULTS There were 85 malignant cases with 59 basal cell carcinomas and 25 squamous cell carcinomas. For basal cell carcinoma, clear margins (≥3 mm), close margins (<3 mm) and positive margins were achieved in 24 (48%), 23 (46%) and three (6%) cases, respectively. For squamous cell carcinoma, clear margins (≥5 mm), close margins (<5 mm) and positive margins were achieved in seven (38.8%), 11 (61.1%) and none (0%) of the cases, respectively. Complications included one haematoma and two wound infections. For 37% of patients living >100 km from the department, 72.3% had local general practitioner follow-up. Inpatient cost was $2870, $5697 and $9300 for primary closure, local flap and full-thickness skin graft, respectively, and outpatient cost was $746 for a single facial lesion. CONCLUSION This study presents a cost-effective model for the management of non-melanoma skin cancers with improved departmental efficiency and streamlined patient care in an outpatient skin cancer management model in a regional centre.
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Affiliation(s)
- James Nightingale
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Liam Travers
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Jakob Campbell
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Johnson Huang
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Megan Green
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Tim Warren
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Garret Fitzgerald
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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141
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Ishii M, Hirai I, Tanese K, Fusumae T, Nakamura Y, Fukuda K, Uchi H, Kabashima K, Otsuka A, Yokota K, Yamazaki N, Namikawa K, Fujimura T, Takenouchi T, Yamamoto Y, Nishiguchi M, Sato Y, Amagai M, Funakoshi T. Anti-PD-1 antibody therapy for epithelial skin malignancies: An investigator-initiated, open-label, single-arm, multicenter, phase II clinical trial (NMSC-PD1 Study). Medicine (Baltimore) 2020; 99:e22913. [PMID: 33126349 PMCID: PMC7598805 DOI: 10.1097/md.0000000000022913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Malignant cutaneous epithelial tumors comprise various skin malignancies originating from the cutaneous epithelium, including cutaneous squamous cell carcinoma, basal cell carcinoma, and malignant cutaneous adnexal tumors. Treatment options are limited, as the rarity of these tumors, especially among Asians, renders well-controlled clinical trials extremely challenging to conduct. Thus, we designed a clinical trial to evaluate the efficacy and safety of the anti-programmed cell death-1 (PD-1) monoclonal antibody nivolumab in patients with metastatic cutaneous squamous cell carcinomas and other rare metastatic cutaneous epithelial tumors. METHODS AND ANALYSIS This is an open-label, single-arm, multicenter, phase 2 clinical trial involving patients with metastatic malignant cutaneous epithelial tumors. Nivolumab (480 mg) will be administered intravenously every 4 weeks for a maximum of 26 doses. The primary outcome of the study will be the response rate based on response evaluation criteria in solid tumors, version 1.1. Assuming a null hypothesis of a response rate ≤5% and an alternative hypothesis of a 25% response rate, a minimum of 26 patients are required to achieve a 5% two-sided type I error and 80% power based on the exact binomial distribution. Finally, a target cohort size of 30 patients was determined as some patient dropout will be expected. DISCUSSION This is the first phase 2 clinical trial evaluating the efficacy and safety of the PD-1 inhibitor nivolumab in Asian patients with metastatic malignant cutaneous epithelial tumors. The findings of the study will contribute to the development of novel treatment approaches for patients with rare cutaneous malignancies, which remains an unmet clinical need. TRIAL REGISTRATION Registry number: jRCT 2031190048.
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Affiliation(s)
- Maki Ishii
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Takayuki Fusumae
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Hiroshi Uchi
- Department of Dermato-oncology, National Hospital Organization Kyushu Cancer Center
| | | | | | - Kenji Yokota
- Department of Dermatology, Nagoya University Hospital
| | - Naoya Yamazaki
- Department of Dermatologic oncology, National Cancer Center Hospital
| | - Kenjiro Namikawa
- Department of Dermatologic oncology, National Cancer Center Hospital
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine
| | | | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University
| | | | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo
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Snaidr VA, Damian DL, Halliday GM. Nicotinamide for photoprotection and skin cancer chemoprevention: A review of efficacy and safety. Exp Dermatol 2020; 28 Suppl 1:15-22. [PMID: 30698874 DOI: 10.1111/exd.13819] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 12/22/2022]
Abstract
Nicotinamide is a water-soluble vitamin B3 derivative that has many roles in medicine. This review examines the role of nicotinamide in dermatology and its actions in preventing photoageing and skin cancers in humans. Nicotinamide prevents ultraviolet radiation (UV) from reducing ATP levels and inhibiting glycolysis, thus preventing the UV radiation-induced energy crisis. This enhances DNA repair and reduces UV-induced suppression of immunity. Randomised controlled clinical trials have also shown that nicotinamide reduces transepidermal water loss and the development of new non-melanoma skin cancers in high-risk humans. This review also examines nicotinamide's safety profile.
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Affiliation(s)
- Victoria A Snaidr
- Discipline of Dermatology, Bosch Institute, University of Sydney and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia
| | - Diona L Damian
- Discipline of Dermatology, Bosch Institute, University of Sydney and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - Gary M Halliday
- Discipline of Dermatology, Bosch Institute, University of Sydney and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia
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143
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Zhao W, Wang J, Zhang Y, Zheng B. A retrospective study comparing different injection approaches of 5-aminolevulinic acid in patients with non-melanoma skin cancer. J DERMATOL TREAT 2020; 33:1465-1472. [PMID: 33016837 DOI: 10.1080/09546634.2020.1832186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND 5-aminolevulinic acid through a needle-free, plum-blossom needle or conventional needle followed by photodynamic therapy are available options for non-melanoma skin cancer treatment. AIM To compare these three techniques of injection of 5-aminolevulinic, regarding treatment response and adverse effects in patients with non-melanoma skin cancer. PATIENTS AND METHODS Non-melanoma skin cancer patients have received six cycles of 0.5 mL intralesional 20% w/v 5-aminolevulinic acid through a conventional needle (CPT cohort, n = 158), or plum-blossom needle (BPT cohort, n = 118), or needle-free injection (NPT cohort, n = 105) followed by irradiation with a red light. Data regarding treatment response and adverse effects were collected and analyzed. RESULTS The treatment response was higher among patients of NPT cohort than those of CPT (p = .012, q = 3.981) and BPT (p = .012, q = 3.472) cohorts. Conventional and plum-blossom needle injections therapies were reported scar, local redness, and worse cosmetic appearance in the follow-up period. CONCLUSIONS Needle-free injection of intralesional 5-aminolevulinic acid followed by irradiation with red light therapy were reported high treatment response with manageable adverse effects for non-melanoma skin cancer patients than that of conventional and plum-blossom needle injections. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Weihong Zhao
- Department of Dermatology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Jun Wang
- Department of Dermatology; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Ying Zhang
- Department of Dermatology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Baoyong Zheng
- Department of Dermatology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
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Ocampo-Garza SS, Ocampo-Candiani J, Orizaga-Y-Quiroga TL, Garza-Rodríguez V. Commentary on Dermoscopy as a complementary tool for positive margin demarcation on the Mohs' map. Australas J Dermatol 2020; 62:e242-e243. [PMID: 33040329 DOI: 10.1111/ajd.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022]
Abstract
Mohs micrographic surgery (MMS) is a technique that allows removal of complex or ill-defined skin cancer, combining tissue preservation and complete microscopic margin control. One of the main challenges of Mohs surgery is to illustrate the exact location of the tumour detected by light microscope. Using a dermoscope allows a fast, easy, reproducible way to accurately illustrate the location of a positive tumour on the Mohs map and ultimately transpose it to the surgical defect of the patient in a more precise way.
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Affiliation(s)
- Sonia Sofía Ocampo-Garza
- Facultad de Medicina y Hospital Universitario ''Dr. Jose E. Gonzalez'', Servicio de Dermatología, Universidad Autonoma de Nuevo Leon, Monterrey, NL, Mexico
| | - Jorge Ocampo-Candiani
- Facultad de Medicina y Hospital Universitario ''Dr. Jose E. Gonzalez'', Servicio de Dermatología, Universidad Autonoma de Nuevo Leon, Monterrey, NL, Mexico
| | - Thelma Laura Orizaga-Y-Quiroga
- Facultad de Medicina y Hospital Universitario ''Dr. Jose E. Gonzalez'', Servicio de Dermatología, Universidad Autonoma de Nuevo Leon, Monterrey, NL, Mexico
| | - Verónica Garza-Rodríguez
- Facultad de Medicina y Hospital Universitario ''Dr. Jose E. Gonzalez'', Servicio de Dermatología, Universidad Autonoma de Nuevo Leon, Monterrey, NL, Mexico
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145
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Stone CE, Onyekaba NA, Lucas M, Jukic D. Cutaneous Secondary Syphilis Resembling Non-Melanoma Skin Cancer. Cureus 2020; 12:e10774. [PMID: 33033668 PMCID: PMC7532864 DOI: 10.7759/cureus.10774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The cutaneous manifestations of secondary syphilis can vary significantly between patients, leading to a more difficult or delayed diagnosis. Here we present an instructive case of secondary syphilis in a 45-year-old, HIV-positive male patient. He presented with a solitary, crusted anterior neck nodule without concomitant systemic symptoms. Together, history and physical exam were concerning for non-melanoma skin cancer. Histopathologic evaluation of the lesion revealed an extensive infiltrate of plasma cells at the dermoepidermal junction, and immunohistochemical staining revealed numerous Treponema pallidum microorganisms. Physicians must keep syphilis in the differential diagnosis when evaluating atypical nodular lesions resembling non-melanoma skin cancer for the purpose of initiating appropriate antibiotic treatment and preventing future infectious complications.
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Affiliation(s)
| | | | - Matthew Lucas
- Dermatology, Winn Army Community Hospital, Fort Stewart, USA
| | - Drazen Jukic
- Dermatology, University of Florida, Gainesville, USA.,Pathology, Mercer University School of Medicine, Savannah, USA.,Dermatopathology, Georgia Dermatopathology, Savannah, USA.,Telepathology, James A. Haley Veterans' Hospital, Tampa, USA
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146
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González-Morán A, Piquero-Casals J. Use of a Topical Film-Forming Medical Device Containing Repairsomes ® in a Patient with Xeroderma Pigmentosum to Avoid Progression to Skin Cancerization. Clin Cosmet Investig Dermatol 2020; 13:677-681. [PMID: 32982361 PMCID: PMC7501962 DOI: 10.2147/ccid.s274423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022]
Abstract
This paper reports a case of xeroderma pigmentosum in a 78-year-old woman with a 17-year history of multiple basal cell carcinomas, keratoacanthoma, and lentigo maligna melanoma, in different photoexposed facial regions. To prevent aggravation of these medical conditions, for five years, the patient had been applying a film-forming topical medical device (MD) containing the DNA-repair enzyme photolyase in liposomes and high-protection UV filters (Repairsomes) twice a day. During this time, the patient had no clinical or dermatoscopic evidence of new skin cancer lesions. However, at her last visit, the patient had a new basal cell carcinoma on the face, in the right supramaxillary area. After questioning, the patient recognized that she had not been applying the product on a regular basis during the last year. This may have been a coincidence; however, there is clinical evidence of the preventive effect of this MD in reducing the cancerization field and consequently the development of skin cancer. This product contains a light-activated flavoenzyme called photolyase which creates the condition to revert cyclobutane pyrimidine dimer. In the discussion of this case, we review recent publications and stress some important aspects on the role of photoprotection and photorepair as a strategy to more effectively reduce the risk of UV-induced premalignant and malignant skin lesions compared to traditional photoprotection strategies.
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147
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Serda M, Szewczyk G, Krzysztyńska-Kuleta O, Korzuch J, Dulski M, Musioł R, Sarna T. Developing [60]Fullerene Nanomaterials for Better Photodynamic Treatment of Non-Melanoma Skin Cancers. ACS Biomater Sci Eng 2020; 6:5930-5940. [PMID: 33320587 DOI: 10.1021/acsbiomaterials.0c00932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Skin cancer is the most common cancer in the U.S.A. and Europe. Its subtype, squamous skin carcinoma (SCC), if allowed to grow, has the potential to metastasize and can become deadly. Currently, carbon nanomaterials are being developed to treat cancer due to their attractive physicochemical and biological properties such as an enhanced permeability effect and their ability to produce reactive oxygen species. Here, we describe the synthesis of two water-soluble aminofullerenes (MonoaminoC60 and HexakisaminoC60), which were evaluated as novel [60]fullerene based photosentizers exhibiting anticancer properties. Moreover, the previously described neutral glycofullerene GF1 and its peracetylated lipophilic precursor MMS48 were compared with the aminofullerenes for their ability to generate reactive oxygen species and oxidize lipids. Remarkably, the generation of singlet oxygen and a superoxide radical by HexakisaminoC60 was found to be markedly elevated in the presence of bovine serum albumin and NADH, respectively. Mechanistic studies of lipid peroxidation using cholesterol as a unique reporter molecule revealed that although all four fullerene nanomaterials primarily generated singlet oxygen, superoxide anion was also formed, which suggest a mixed mechanism of action (in which Type I and Type II photochemistry is involved). The [60]fullerene derivative HexakisaminoC60 was also studied for its phototoxicity in squamous skin cancer cell line (A431) using the MTT test and propidium iodide staining.
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Affiliation(s)
- Maciej Serda
- Institute of Chemistry, University of Silesia in Katowice, Katowice 40-007, Poland
| | - Grzegorz Szewczyk
- Faculty of Biochemistry, Biophysics, and Biotechnology, Jagiellonian University, Kraków 30-387, Poland
| | - Olga Krzysztyńska-Kuleta
- Faculty of Biochemistry, Biophysics, and Biotechnology, Jagiellonian University, Kraków 30-387, Poland
| | - Julia Korzuch
- Institute of Chemistry, University of Silesia in Katowice, Katowice 40-007, Poland
| | - Mateusz Dulski
- Institute of Materials Engineering, University of Silesia in Katowice, 75 Pulku Piechoty 1A, Chorzów 41-500, Poland.,Silesian Center for Education and Interdisciplinary Research, University of Silesia in Katowice, 75 Pulku Piechoty 1A, 41-500 Chorzów, Poland
| | - Robert Musioł
- Institute of Chemistry, University of Silesia in Katowice, Katowice 40-007, Poland
| | - Tadeusz Sarna
- Faculty of Biochemistry, Biophysics, and Biotechnology, Jagiellonian University, Kraków 30-387, Poland
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148
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Nikolouzakis TK, Falzone L, Lasithiotakis K, Krüger-Krasagakis S, Kalogeraki A, Sifaki M, Spandidos DA, Chrysos E, Tsatsakis A, Tsiaoussis J. Current and Future Trends in Molecular Biomarkers for Diagnostic, Prognostic, and Predictive Purposes in Non-Melanoma Skin Cancer. J Clin Med 2020; 9:E2868. [PMID: 32899768 PMCID: PMC7564050 DOI: 10.3390/jcm9092868] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Skin cancer represents the most common type of cancer among Caucasians and presents in two main forms: melanoma and non-melanoma skin cancer (NMSC). NMSC is an umbrella term, under which basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Merkel cell carcinoma (MCC) are found along with the pre-neoplastic lesions, Bowen disease (BD) and actinic keratosis (AK). Due to the mild nature of the majority of NMSC cases, research regarding their biology has attracted much less attention. Nonetheless, NMSC can bear unfavorable characteristics for the patient, such as invasiveness, local recurrence and distant metastases. In addition, late diagnosis is relatively common for a number of cases of NMSC due to the inability to recognize such cases. Recognizing the need for clinically and economically efficient modes of diagnosis, staging, and prognosis, the present review discusses the main etiological and pathological features of NMSC as well as the new and promising molecular biomarkers available including telomere length (TL), telomerase activity (TA), CpG island methylation (CIM), histone methylation and acetylation, microRNAs (miRNAs), and micronuclei frequency (MNf). The evaluation of all these aspects is important for the correct management of NMSC; therefore, the current review aims to assist future studies interested in exploring the diagnostic and prognostic potential of molecular biomarkers for these entities.
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Affiliation(s)
- Taxiarchis Konstantinos Nikolouzakis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece;
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (K.L.); (E.C.)
| | - Luca Falzone
- Epidemiology Unit, IRCCS Istituto Nazionale Tumori ‘Fondazione G. Pascale’, I-80131 Naples, Italy;
| | - Konstantinos Lasithiotakis
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (K.L.); (E.C.)
| | | | - Alexandra Kalogeraki
- Department of Pathology-Cytopathology, Medical School, University of Crete, 70013 Heraklion, Crete, Greece;
| | - Maria Sifaki
- Centre of Toxicology Science and Research, Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece;
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece;
| | - Emmanuel Chrysos
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (K.L.); (E.C.)
| | - Aristidis Tsatsakis
- Centre of Toxicology Science and Research, Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece;
| | - John Tsiaoussis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece;
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149
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Sinclair R, Baker C, Spelman L, Supranowicz M, MacMahon B. A review of actinic keratosis, skin field cancerisation and the efficacy of topical therapies. Australas J Dermatol 2020; 62:119-123. [PMID: 32840870 PMCID: PMC8247342 DOI: 10.1111/ajd.13447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 12/14/2022]
Abstract
While a wide range of treatments exist for actinic keratosis and skin field cancerisation, the long‐term benefits of the most common topical therapies are poorly defined. This report reviews the efficacy of the most commonly used topical therapies to treat regional or field lesions. Limited clinical and histopathological data are available on clearance rates at 12 months post‐treatment for the most commonly used agents, with varied outcome measures making any comparison difficult. In general, total field clearance rates at 12 months are suboptimal for the most commonly employed agents. Given the increasing incidence of actinic keratosis and skin field cancerisation due to an ageing population, further research into the efficacy of therapies is critical to guide treatment choice.
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Affiliation(s)
- Robert Sinclair
- Specialist Connect Services, Brisbane, Queensland, Australia
| | | | - Lynda Spelman
- Specialist Connect Services, Brisbane, Queensland, Australia
| | | | - Beth MacMahon
- Specialist Connect Services, Brisbane, Queensland, Australia
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150
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Pianosi K, Jordan K, Moore CC. Near-infrared heating of skin to delineate non-melanoma skin cancer lesions: A pilot study. Skin Res Technol 2020; 27:234-240. [PMID: 32713072 DOI: 10.1111/srt.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical excision is a mainstay of treatment for non-melanoma skin cancer (NMSC); improving margin delineation can reduce the need for further monitoring/treatment. The objective of this pilot study was to determine if near-infrared radiation (NIR) application to skin causes visible changes in normal and NMSC skin, to help delineate margins. MATERIALS/METHODS Eleven biopsy-proven NMSC lesions were included. The skin was then heated under a 175W NIR heating bulb; margins were traced onto acetate film before and after heating. Lesions were then randomly assigned to excision based on pre- or post-heating margins. Composite images were generated by overlaying the heat and no-heat lesion contours. All specimens were sent for histopathology. RESULTS The range of closest margins in the control group was 2.0-3.0 mm with a median of 2.0 mm; the range in the intervention group was 4.0-9.0 mm with a median of 5.0 mm. Composite images showed larger heat contours when the initial lesion was larger. There was a statistically significant difference between the two groups. Overall, NIR light caused visible hyperaemia to skin, and more intense erythema to malignant skin lesions. CONCLUSION Near-infrared light may have use in an outpatient setting for skin cancer delineation, possibly reducing the rate of positive margins.
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Affiliation(s)
- Kiersten Pianosi
- Department of Otolaryngology - Head & Neck Surgery, University of Western Ontario, London, ON, Canada
| | - Kevin Jordan
- Departments of Oncology and Medical Biophysics, University of Western Ontario, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Corey C Moore
- Department of Otolaryngology - Head & Neck Surgery, University of Western Ontario, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
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