Incidence and Mortality of Malignant Melanoma in Relation to Dermatologist Density in Bavaria

Impact of Patient's Age and Physician's Professional Background on the Number Needed to Treat in Malignant Melanoma Detection

Background/Objectives: With regard to excision of pigmented lesions for detection of malignant melanoma (MM), the number needed to treat (NNT) describes the number of melanocytic nevi that need to be biopsied/excised to detect one MM. The aim should be a low NNT. Methods: Single-center data analysis, including dermatohistopathological records of all nevi and MM cases during 2004-2013 at the Department of Dermatology, University Hospital Regensburg (UKR), was performed. We calculated the NNT, correlating it with the patient's age and referring physician. The MM to MM in situ ratio was calculated to quantify early detection. As a secondary objective, we stratified into a pre- and post-2008 dataset, coinciding with the introduction of statutory skin cancer screening in Germany. Results: The overall NNT of 118,668 pigmented lesions was 17.2. We found a linear decrease in NNT towards older patients (R2 = 62%; p < 0.001). The impact of skin cancer screening in 2008 was marked by a reduction in biopsies/excisions, a shift in age distribution, and a decrease in the NNT from 20.3 to 14.7. Office-based dermatologists had an NNT of 22.3, UKR-based dermatologists had an NNT of 8.0, and non-dermatologists had an NNT of 16.5. Conclusions: The age-related decrease in the NNT emphasizes the importance of age stratification for pigmented lesions. The NNT differed between professional settings. The implementation of skin cancer screening in 2008 was associated with a reduced NNT.

Skin cancer in Germany: Characterising screening, prevalence and mortality from a spatial perspective

Aim of the study was to characterise the association between screening, prevalence and mortality of skin cancer in Germany considering the spatial distribution. The study included the total set of outpatient data of all statutory health insured people and cause-of-death statistics in Germany between 2011-2015 on county level. To identify regions with high/low screening, prevalence and mortality rates, probability maps were calculated. Scenarios were developed based on the research questions. These were used to identify regions that share both high/low rates of screening, prevalence and mortality. Regression analyses were used to characterise these regions, taking into account sociodemographic characteristics. Significant regional variations in prevalence, screening and mortality in Germany were identified. Depending on the scenario, influences of sociodemographic conditions become apparent. For example, a lower income (p = 0.006) and poorer accessibility of the closest dermatologist (p = 0.03) predicted a lower prevalence of and fewer screenings for skin cancer. In regions with low screening and high mortality, significant (p = 0.03) associations with the educational status of the population were also found. The study identified the first spatial associations between screening, prevalence and mortality of skin cancer in Germany. The results indicate that regional population-related characteristics (e.g., sociodemographic characteristics) play an important role in explaining the associations and should be given more weight in further studies. However, further studies, particularly on the spatial variation of skin cancer mortality, are still necessary.

Screening of anti-melanoma compounds from Morus alba L.: Sanggenon C promotes melanoma cell apoptosis by disrupting intracellular Ca2+ homeostasis

ETHNOPHARMACOLOGICAL RELEVANCE

Morus alba L. is a widespread plant that has long been considered to have remarkable medical values, including anti-inflammation in Traditional Chinese Medicine (TCM). The components of Morus Alba L. constituents have been extensively studied and have been shown to have high prospects for cancer therapy. However, limited investigations have been done on the bioactive compounds in Morus alba L.

AIM OF THE STUDY

This study aimed to systematically examine the anticancer properties of 28 commercially available compounds from Morus alba L. against melanoma cells in vitro. Additionally, the anticancer mechanisms of the bioactive compound exhibiting the most significant potential were further studied.

MATERIALS AND METHODS

The anti-proliferative effects of Morus alba L.-derived compounds on melanoma cells were determined by colony formation assays. Their effects on cell viability and apoptosis were determined using the CCK8 assay and flow cytometry, respectively. The binding affinity of identified Morus alba L. compounds with anticancer activities towards melanoma targets was analyzed via molecular docking. The molecular mechanism of Sanggenon C was explored using soft agar assays, EdU incorporation assays, flow cytometry, western blotting, transcriptome analysis, and xenograft assays.

RESULTS

Based on colony formation assays, 11 compounds at 20 μM significantly inhibited colony growth on a panel of melanoma cells. These compounds displayed IC50 values (half maximal inhibitory concentrations) ranging from 5 μM to 30 μM. Importantly, six compounds were identified as novel anti-melanoma agents, including Sanggenon C, 3'-Geranyl-3-prenyl-2',4',5,7-tetrahydroxyflavone, Moracin P, Moracin O, Kuwanon A, and Kuwanon E. Among them, Sanggenon C showed the most potent effects, with an IC50 of about 5 μM, significantly reducing proliferation and inducing apoptosis in melanoma cells. Based on the xenograft model assay, Sanggenon C significantly inhibited melanoma cell proliferation in vivo. Sanggenon C triggered ER stress in a dose-dependent manner, which further disrupted cellular calcium ion (Ca2+) homeostasis. The Ca2+ chelator BAPTA partially restored cell apoptosis induced by Sanggenon C, confirming that Ca2+ signaling contributed to the anticancer activity of Sanggenon C against melanoma.

CONCLUSIONS

In our study, 11 compounds demonstrated anti-melanoma properties. Notably, Sanggenon C was found to promote apoptosis by disrupting the intracellular calcium homeostasis in melanoma cells. This study provides valuable information for the future development of novel cancer therapeutic agents from Morus alba L.

Zusammenhang zwischen der Inzidenz früher Stadien und der Mortalität beim malignen Melanom - eine bevölkerungsbasierte ökologische Studie

Hintergrund

In Deutschland wurde 2008 ein flächendeckendes Hautkrebsscreening eingeführt, um die Hautkrebsmortalität und ‐morbidität zu senken. Noch unklar ist jedoch die Wirksamkeit des Programms. Wir untersuchen den Zusammenhang zwischen der Inzidenz von Melanom‐Frühstadien und Melanom‐Mortalität in den Folgejahren, wobei die Inzidenz von Melanom‐Frühstadien als Surrogatparameter für Screening‐Teilnahme und Früherkennung verwendet wird.

Methodik

Für 244 deutsche Landkreise wurden Daten zur Melanom‐Inzidenz von 2005–2016 und zur Melanom‐Mortalität von 2005–2018 erhoben. Die Zusammenhänge zwischen verschiedenen Maßen der Inzidenz und Mortalität wurden mit Korrelationsanalysen und linearen Regressionen untersucht.

Ergebnisse

Die Melanom‐Inzidenz früher Stadien (in situ und T1) stieg nach Einführung des Screenings (2005–2007 vs. 2008–2010) um 69%. Im Gegensatz dazu gab es bei der Mortalität keinen zeitlichen Trend. Die Korrelationen zwischen Inzidenz‐ und Mortalitätsvariablen lagen zwischen –0,14 und 0,10 (nicht signifikant). Die linearen Regressionsanalysen ergaben, dass die Mortalität sechs Jahre nach Einführung des Screenings mit zunehmendem Anstieg der Inzidenz früher Stadien abnimmt (b  =  –0,0029, 95%‐Konfidenzintervall [–0,0066; 0,0007]).

Schlussfolgerungen

Die geschätzten bevölkerungsbezogenen Auswirkungen des Hautkrebsscreenings auf die Melanom‐Mortalität waren minimal und nicht signifikant. Eine mögliche Wirksamkeit kann daher nicht nachgewiesen werden.

Association of early-stage incidence and mortality in malignant melanoma - a population-based ecological study

BACKGROUND

Germany-wide skin cancer screening was introduced in 2008 to reduce skin cancer mortality and morbidity. However, the effectiveness of the program is still unclear. We explore the relationship between early-stage melanoma incidence and melanoma mortality in subsequent years, using early-stage melanoma incidence as surrogate for screening participation and early detection.

PATIENTS AND METHODS

Data on melanoma incidence for 2005-2016 and melanoma mortality for 2005-2018 were obtained for 244 German counties. We investigated the correlation between several measures of incidence and mortality with correlation analyses and linear regressions.

RESULTS

Melanoma incidence of early stages (in situ and T1) rose by 69% between pre-screening (2005-2007) and screening period (2008-2010). In contrast, there was no temporal trend in mortality over time. Correlation coefficients between incidence and mortality variables ranged between -0.14 and 0.10 (not significant). Linear regression indicated that mortality 6 years after screening introduction decreases with increasing change in early-stage incidence (b = -0.0029, 95% confidence interval [-0.0066, 0.0007]).

CONCLUSIONS

The estimated population-based effects of skin cancer screening on melanoma mortality were minimal and not significant. A potential effectiveness cannot be demonstrated.

Search for immunomodulatory compounds with antiproliferative activity against melanoma

BACKGROUND

Melanoma is a highly aggressive neoplasm with a high degree of malignancy and rapid acquisition of resistance by cancer cells.

METHODS

Biological studies of a series of isoxazole compounds with immunomodulatory properties were preceded by in silico analysis. The assay evaluated the viability of NHDF and A375 cell cultures after the administration of isoxazole compounds after a 24-hour incubation period in the MTT test. Analyzes of ROS and NO scavenging, P-glycoprotein activity, and properties were performed. The levels of Caspase 3 and Caspase 9 were measured using ELISA to assess which pathways induced apoptosis by the tested compounds. On the chip, the synergistic effect of doxorubicin and the most active compound from the MM9 series on cells of the A375 melanoma line was determined.

RESULTS

All tested N'-substituted derivatives of 5-amino-N,3-dimethyl-1,2-oxazole-4-carbohydrazide with immunomodulatory activity show multidirectional antitumor activity on A375 melanoma lines with an affinity for P-glycoprotein, induction of free radical formation and generation of DNA damage leading to the death of cancer cells, as well as formation of complexes with DNA Topoisomerase II. Most of the tested compounds show pro-apoptotic activity. The most active compound in the series induces apoptosis in three distinct pathways and acts synergistically with doxorubicin.

CONCLUSIONS

The most active compound with immunomodulatory properties showed multidirectional antitumor activity against cells of the A375 melanoma line and also had a synergistic pro-apoptotic effect with doxorubicin, which may result in a reduction of this cytostatic dose with increased effectiveness.

Degree of Actinic Elastosis Is a Surrogate of Exposure to Chronic Ultraviolet Radiation and Correlates More Strongly with Cutaneous Squamous Cell Carcinoma than Basal Cell Carcinoma

(1) Background: Keratinocyte cancer (KC) is associated with exposure to ultraviolet (UV) radiation. However, data are controversial as to whether chronic UV exposure or high intermittent UV exposure are key drivers of carcinogenesis in cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). Prolonged sun exposure of the skin causes photo-aging, which is associated with actinic elastosis, a condition characterized by the degeneration of elastin in the upper dermis, which is assessable via conventional histology. In this study, we aimed to compare the degree of actinic elastosis in different types of KC with regard to various patient characteristics. (2) Methods: We defined a semiquantitative score for the degree of actinic elastosis ranging from 0 = none to 3 = total loss of elastic fibers (basophilic degeneration). The extent was measured histometrically by two independent dermatohistopathologists in the immediate vicinity of 353 KC. The scores were merged and matched with tumor types (cSCC and BCC with subtypes), and clinical variables such as body site, sex and age. (3) Results: As expected, the degree of actinic elastosis correlated with age. However, it was significantly higher in cSCC compared to BCC irrespective of age, sex, body site and tumor subtypes. (4): Conclusions: Lifetime sun exposure may be estimated via routine histology using this scoring technique for actinic elastosis as a surrogate marker. cSCCs are more strongly associated with chronic UV exposure than BCCs, even in sun-exposed localizations such as the face.

Influencing Mechanism of Nod-Like Receptor Protein 3 Inflammasome Activation in A375 Cell Activity in Human Cutaneous Malignant Melanoma

This work was to investigate mechanism by which mir-22 targeting nod-like receptor protein 3 (NLRP3) inflammasome affected activity of human skin malignant melanoma (MM) A375 cells. Twenty-four mice were rolled into a control group (Group X) and an experimental group (Group Y) randomly. Without treatment in Group X, Group Y established MM model. After cell transfection, the mice were divided into group A (blank group), group B (negative group), group C (miR-22 mimics group), group D (miR-22 inhibitor group), and group E (miR-22 inhibitor+siNLRP3 group). The results were summarized as follows. The level of miR-22 mRNA in Group Y was obviously lower than that in Group X, and levels of NLRP3 and caspase-1 mRNA and NLRP3 and caspase-1 protein in Group Y were greatly higher than those in Group X (P < 0.05). The mRNA levels of miR-22 mRNA in group C were much higher in contrast to those in group A, and the mRNA levels of NLRP3 and caspase-1 were lower. The contrast results in group D and group A were the opposite, P < 0.05. The levels of NLRP3 and caspase-1 proteins in group C were greatly elevated, and those in group D were decreased compared with those in group A (P < 0.05). Therefore, miR-22 may target and inhibit the activation of the NLRP3 inflammasome to reduce the activity of cutaneous malignant melanoma A375 cells.

An Intracellular Self-Assembly-Driven Uninterrupted ROS Generator Augments 5-Aminolevulinic-Acid-Based Tumor Therapy

Free radical therapy based on 5-aminolevulinic acid (ALA, a precursor of the photosensitizer protoporphyrin IX (PpIX)) has been approved by the US Food and Drug Administration for clinical tumor treatment. However, PpIX can be quickly converted into photoinactive heme, leading to unexpectedly paused production of free radicals and severely hindering its therapeutic benefits. Here, inspired by the natural biotransformation of ALA (ALA-PpIX-heme), an uninterrupted reactive oxygen species generator (URG) that converts useless heme to peroxidase mimics via intracellular self-assembly is developed. The URG is prepared by enwrapping ALA-loaded polyamide-amine dendrimers in red blood cell membrane vesicles with a further surface modification of G-quadruplex-structured AS1411. The URGs realize "¹ O₂ -•OH" uninterrupted generation through "recycling waste" in two steps: i) PpIX generates ¹ O₂ under laser irradiation; and ii) the photoinactive metabolite heme self-assembled with AS1411 to catalyze H₂ O₂ conversion into •OH. Interestingly, the specific generation of ¹ O₂ in mitochondria and •OH in nuclei further augments the free-radical-induced damage. It is demonstrated that URG can continuously produce free radicals for 6 h postirradiation, and shows 3.3-times more than that of the nonassembly group, achieving nearly 80% regression of tumors in vivo.