Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study

Burden of Skin Cancer in Older Adults From 1990 to 2021 and Modelled Projection to 2050

Importance

Skin cancer is a significant public health threat in the aging population, yet data on its burden and trends are limited.

Objective

To evaluate the global burden of skin cancer among adults 65 years or older from 1990 to 2021, and to project its change to 2050.

Design, Setting, and Participants

In this observational study, population-based registry data were extracted from the Global Burden of Diseases (GBD) Study 2021. The database covers 204 countries and territories, ensuring global applicability of the results. Data analysis was conducted from June 9, 2024, to February 18, 2025.

Main Outcomes and Measures

Age-standardized rates of prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) were calculated per 100 000 population. Estimated rates of disease burden were calculated for 2050.

Results

A worldwide total of 153 993 melanoma, 1 463 424 squamous cell carcinoma (SCC), and 2 802 354 basal cell carcinoma (BCC) instances were estimated for 2021. SCC exhibited the highest age-standardized rate of prevalence (236.91 per 100 000 population; 95% uncertainty interval [UI], 188.23-303.82), deaths (6.16 per 100 000 population; 95% UI, 5.13-6.87), and DALYs (95.50 per 100 000 population; 95% UI, 81.65-106.39), whereas BCC displayed the highest incidence rate (371.97 per 100 000 population; 95% UI, 310.75-439.58). The disease burden was notably greater in male individuals than in female individuals. During the observation period, the global burden of skin cancer among older people demonstrated a general upward trend. Decomposition analysis indicated that population growth was the primary contributor to this increase. Health-inequality analysis revealed a disproportionately higher burden shouldered by countries with higher sociodemographic index (SDI) levels. Frontier analysis identified the countries with considerable potential to mitigate skin cancer. It was anticipated that only incidence and prevalence rates attributable to keratinocyte cancer (KC), along with DALYs rate related to BCC, would increase by 2050.

Conclusions and Relevance

The older population (particularly male individuals and those living in high-SDI countries) is facing a substantial growing burden of skin cancer. Despite the relative incompleteness of KC data and lack of race and ethnicity data, these results highlight the urgency for more effective prevention and management strategies targeting high-risk groups.

Geospatial Analysis of Cutaneous Malignant Melanoma Epidemiology in Europe From 2017 to 2021

BACKGROUND

Cutaneous melanoma is the most aggressive form of skin cancer. Although some studies have explored the epidemiology of melanoma in Europe, there is limited data on its spatial distribution.

MATERIALS AND METHODS

A longitudinal ecological study was conducted to analyze melanoma incidence and mortality from 2017 to 2021 using data from the Global Burden of Disease database. Cases were identified using the International Classification of Diseases (ICD)-9 and ICD-10 codes for both sexes across four European geographical regions, excluding Russia. Age-standardized incidence and mortality rates were calculated. A distance-based spatial weights matrix was generated using GeoDa software to define neighborhood structure. Hotspot analysis of spatial clusters was conducted using the Getis-Ord Gi* statistic. Additionally, the mortality-to-incidence ratio was calculated.

RESULTS

Between 2017 and 2021, a total of 606,448 new melanoma cases were diagnosed in Europe. Both sexes exhibited higher incidence and mortality rates in Northern Europe. All rates were consistently lower in women. For both sexes, incidence hotspots were identified in Sweden, Denmark, the Netherlands, and the United Kingdom. In contrast, mortality hotspots are primarily observed in the Nordic countries, as well as in Eastern Europe. Incidence coldspots are predominantly found in southeastern Europe, whereas mortality coldspots are primarily concentrated in Spain and Portugal. The overall mortality-to-incidence ratio in Europe remained stable during the period, with an evident east-west gradient and higher mortality relative to incidence observed in Eastern Europe.

CONCLUSION

This analysis reveals distinct geographical patterns, characterized by a north-south gradient in incidence and mortality. In contrast, the mortality-to-incidence ratio follows an east-west gradient, highlighting significant disparities in healthcare access.

Attenuated Salmonella carrying IL-21 overexpression plasmid enhances radiotherapy efficacy in a preclinical model of melanoma

Melanoma, known for its aggressive behavior and tendency to metastasize to the brain and lungs, is a formidable challenge in oncology. Radiotherapy is a potent treatment for localized solid tumors, effective against both intracranial and extracranial metastases. Yet, some melanoma patients exhibit substantial resistance to radiotherapy, with the underlying mechanisms of this resistance remaining elusive. While radiotherapy can stimulate the infiltration of immune cells, thereby triggering a range of immunostimulatory effects, it can also suppress the tumor microenvironment (TME), limiting its effectiveness. In physiological conditions, cytokines inhibit the activity of immunosuppressive cells through paracrine and autocrine signaling, while also activating immune cells to boost antitumor responses. Here, we found that Interleukin (IL)-21 expression was higher in the mice with good radiotherapy response to melanoma than in the mice with poor radiotherapy response. Interestingly, we also observed the higher infiltration of M2 TAMs and lower CD8+ T cells in the group with poor radiotherapy response. To tackle this issue, we explored the therapeutic potential of a plasmid encoding IL-21, delivered via attenuated Salmonella, in mice bearing melanomas. Our findings revealed that IL-21 administration significantly reduced M2 TAMs infiltration and enhanced CD8+ T cells infiltration and granzyme B (GZMB) expression within melanoma tumors. Most importantly, the combination of IL-21 with radiotherapy led to markedly tumor reduction compared to either treatment alone. This research highlights the potential of IL-21 as a valuable adjunct to radiotherapy in the treatment of melanoma, presenting a promising strategy for enhancing antitumor immune responses and optimizing patient outcomes.

Patterns and trends in melanoma mortality in Spain (1999-2022)

AIM

To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences.

METHODS

Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes.

RESULTS

Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: - 1.3%). A national trend reversal occurred in 2014 (AAPC: - 1.3%). For individuals aged 45-74 years, Catalonia saw a significant decrease (AAPC: - 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: - 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities.

CONCLUSION

Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide.

Evolving Landscape of Melanoma in Portugal, Spain, Italy, and Greece: Trends and Insights

OBJECTIVE

To study melanoma incidence trends from 1990 to 2021 in Southern European countries-Portugal, Spain, Italy, Greece-and explore regional and age-period-cohort (A-P-C) patterns.

METHODS

Data from the Global Burden of Disease Study 2021 were used to calculate age-standardized incidence rates (ASIRs). Joinpoint regression and age-period cohort (A-P-C) models were applied to identify trends and patterns.

RESULTS

A substantial increase in melanoma ASIRs was observed across all Southern European countries from 1990 to 2021. Joinpoint analysis revealed a potential turning point in the 2010s, with ASIRs stabilizing or declining in younger age groups across all countries. For instance, rates among younger women in Italy, Portugal, and Spain have shown signs of stabilization or decline, while Greek women experienced a continued but slower increase. Men exhibited a similar trend, except for Greece, where the increase rate persisted albeit at a slower pace. Gender differences were evident, with younger women generally facing higher risks vs men but exhibiting a slower rise in incidence with age. The A-P-C analysis confirmed a pronounced cohort effect, indicating a higher risk for melanoma among earlier birth cohorts. Among younger generations, there is evidence of stabilization or even a decline in incidence rates.

CONCLUSION

Melanoma rates are rising in Southern Europe, especially among men. While younger populations show promising declines, likely due to sun protection efforts, older generations continue to be affected. Addressing regional disparities and sustaining these positive trends requires ongoing efforts and comprehensive prevention strategies.

HDAC3 and Snail2 complex promotes melanoma metastasis by epigenetic repression of IGFBP3

The treatment of metastatic melanoma has long posed a complex challenge within clinical practice. Previous studies have found that EMT transcription factors are essential in the development of various cancers through their induction of EMT. Here, we demonstrate that Snail2 expression is dramatically increased in melanoma and is associated with an adverse prognosis. Elevated Snail2 in melanoma cells enhanced migratory and invasive capabilities in vitro and in vivo. Furthermore, RNA-Seq analysis revealed a significant reduction of IGFBP3 expression in melanoma cells overexpressing Snail2. IGFBP3 might mitigate the Snail2's ability to promote melanoma metastasis via the PI3K-AKT pathway. Moreover, Snail2 and HDAC3 collaborate to suppress IGFBP3 transcription through H3K4 deacetylation and H4K5 delactylation. Additionally, the combination of HDAC3 and p-GSK-3β inhibitors significantly improved the treatment outcomes for lung metastasis in melanoma in vivo. The results of our study indicate that Snail2, HDAC3, and IGFBP3 play significant roles in melanoma progression and represent promising therapeutic targets.

Evolving Landscape of Melanoma in Portugal, Spain, Italy, and Greece: Trends and Insights

OBJECTIVE

To study melanoma incidence trends from 1990 to 2021 in Southern European countries-Portugal, Spain, Italy, Greece-and explore regional and age-period-cohort (A-P-C) patterns.

METHODS

Data from the Global Burden of Disease Study 2021 were used to calculate age-standardized incidence rates (ASIRs). Joinpoint regression and age-period cohort (A-P-C) models were applied to identify trends and patterns.

RESULTS

A substantial increase in melanoma ASIRs was observed across all Southern European countries from 1990 to 2021. Joinpoint analysis revealed a potential turning point in the 2010s, with ASIRs stabilizing or declining in younger age groups across all countries. For instance, rates among younger women in Italy, Portugal, and Spain have shown signs of stabilization or decline, while Greek women experienced a continued but slower increase. Men exhibited a similar trend, except for Greece, where the increase rate persisted albeit at a slower pace. Gender differences were evident, with younger women generally facing higher risks vs men but exhibiting a slower rise in incidence with age. The A-P-C analysis confirmed a pronounced cohort effect, indicating a higher risk for melanoma among earlier birth cohorts. Among younger generations, there is evidence of stabilization or even a decline in incidence rates.

CONCLUSION

Melanoma rates are rising in Southern Europe, especially among men. While younger populations show promising declines, likely due to sun protection efforts, older generations continue to be affected. Addressing regional disparities and sustaining these positive trends requires ongoing efforts and comprehensive prevention strategies.

Socioeconomic status correlates with clinical outcomes in patients with acral melanoma

Objectives

This study aimed to investigate the impact of socioeconomic status on survival in Chinese patients with acral melanoma.

Methods

We collected clinical and socioeconomic information of 298 primary acral melanoma patients and performed Kaplan-Meier curves, log-rank tests, Cox proportional hazards models, and Pearson's chi-squared tests to evaluate the relationships between clinical characteristics, socioeconomic factors, and survival outcomes.

Results

Among the clinical characteristics, age, gender, stage, Breslow thickness, and primary tumor site significantly impacted survival in acral melanoma patients (p = 0.01, p = 0.05, p < 0.01, p < 0.01, p < 0.01, respectively). Compared to individual socioeconomic factors such as education, occupation, medical insurance, and marital status, the socioeconomic level derived from these four dimensions accurately predicted patient survival. Patients with higher socioeconomic status demonstrated significantly reduced mortality risk (HR = 0.60, 95% CI = 0.40-0.91, p = 0.02). However, socioeconomic level was not found to be an independent prognostic factor for acral melanoma patients after multivariable adjustment. Notably, a negative correlation was observed between socioeconomic level and Breslow thickness.

Conclusion

Socioeconomic level is associated with survival in Chinese acral melanoma patients. However, this association may be attributable to Breslow thickness rather than socioeconomic status itself.

Who visits primary health care general practitioners and why? A register-based study in a Finnish city

This is a register-based study that examines the distribution of diagnoses made by general practitioners (GPs) in the public primary health care of the city of Vantaa, Finland. Data were gathered from the electronic health record (EHR) system and consisted of every record entered into the EHR system between 1 January 2016 and 31 December 2018. Both absolute numbers and relative proportions of the 10th edition of International Classification of Diseases (ICD-10) diagnosis recordings were reported and calculated. Among GP visits, the 88 most common diagnoses covered 75% of all diagnoses. The most common diagnoses were related to the musculoskeletal (3.8%, ICD code M54) and respiratory systems (6.0%, ICD-10 code J06). Primary health care GP services were mostly used by children (age <5 years) and older adults (>65 years). Health examinations - mostly children's and maternity clinics appointments/visits - covered 20% of the GP office visits. Women between the ages 15-79 years had relatively more GP visits compared to men. The 88 most commonly recorded diagnoses covered the majority of the GP visits. Health examinations for the healthy were an important part of GPs' work. In an urban Finnish city, GP services were predominantly used by children and older adults.

Extracellular Matrix as a Target in Melanoma Therapy: From Hypothesis to Clinical Trials

Melanoma is a malignant, highly metastatic neoplasm showing increasing morbidity and mortality. Tumor invasion and angiogenesis are based on remodeling of the extracellular matrix (ECM). Selective inhibition of functional components of cell-ECM interaction, such as hyaluronic acid (HA), matrix metalloproteinases (MMPs), and integrins, may inhibit tumor progression and enhance the efficacy of combination treatment with immune checkpoint inhibitors (ICIs), chemotherapy, or immunotherapy. In this review, we combine the results of different approaches targeting extracellular matrix elements in melanoma in preclinical and clinical studies. The identified limitations of many approaches, including side effects, low selectivity, and toxicity, indicate the need for further studies to optimize therapy. Nevertheless, significant progress in expanding our understanding of tumor biology and the development of targeted therapies holds great promise for the early approaches developed several decades ago to inhibit metastasis through ECM targeting.

The Potential of Circulating miR-193b, miR-146b-3p and miR-483-3p as Noninvasive Biomarkers in Cutaneous Melanoma Patients

Melanoma is a destructive skin disease with few therapeutic options in the developed stage and therefore there is a critical need for reliable biomarkers for early diagnosis. In this context, microRNAs could play an important role as diagnostic biomarkers. Three datasets with accession numbers GSE31568, GSE61741 and GSE20994 were downloaded from the Gene Expression Omnibus (GEO) database. MATLAB software was used to analyze differentially expressed miRNAs between cutaneous melanoma plasma samples and normal plasma samples (control). Plasma levels of miR-193b, miR-146b-3p and miR-483-3p were evaluated by the RT-PCR method. Furthermore, linear regression followed by receiver operating characteristic analyses was performed to estimate whether selected plasma miRNAs were able to distinguish between cases and controls. Finally, the data were analyzed by unpaired Mann-Whitney U test using Graph pad prism 8 computer software. Specifically, miR-193b and miR-146b-3p were downregulated in the plasma of melanoma patients compared with control groups which were decreased 5 × 10 6 -fold in miR-193b and 58-fold in miR-146b-3p, while miR-483-3p was upregulated 3.5-fold. After receiver operating characteristic (ROC) curve analysis, miR-193b with the most area under the curve (AUC: 1.00, 95% confidence interval 1.00-1.00, p < 0.0001) had the best discriminatory power, and miR-146b-3p had the large area under the curve (AUC: 0.96, 95% confidence interval 0.96-1.00, p < 0.0001) and consequently the high discriminatory power. Between these three miRNAs, miR-193b and miR-146b-3p had a high capacity to distinguish between melanoma patients and control groups that are appropriate to be applied in melanoma diagnosis as an early and noninvasive method.

CXCL10 promotes melanoma angiogenesis and tumor growth

Upregulation of CXC motif chemokine 10 (CXCL10) in melanoma patients has been found to be associated with melanoma progression. However, the role of endogenous CXCL10 from the host in melanoma tumor growth remains unclear. In the present study, we found that host-derived endogenous CXCL10 production was dramatically augmented during subcutaneous B16F10 melanoma tumor growth and that host ablation of CXCL10 in Cxcl10-/- mice showed a decrease in both angiogenesis and tumor growth of B16F10 melanoma in vivo. Several signaling pathways involved in production of pro-angiogenic factors and tumor growth were activated by CXCL10 in B16F10 melanoma cells. CXCL10 increased expression of pro-angiogenic factors, such as vascular endothelial growth factor (VEGF), platelet-derived growth factor subunit-B (PDGF-B), fibroblast growth factor 2 (FGF2), hepatocyte growth factor (HGF), and angiopoietin 2 (Angpt2), in B16F10 melanoma cells, resulting in enhanced tube formation and proliferation of human umbilical vein endothelial cells in vitro. In addition, CXCL10 directly enhanced B16F10 melanoma tumor growth in an in vitro three-dimensional cell culture system. Together, our findings reveal that amplified host-derived endogenous CXCL10 is critical for B16F10 melanoma angiogenesis and tumor growth. Therefore, CXCL10 might represent a therapeutic target for melanoma.

Increasing melanoma incidence with unchanged mortality: more sunshine, better treatment, increased diagnostic activity, overdiagnosis or lowered diagnostic threshold?

BACKGROUND

Increasing melanoma incidence with less increasing mortality is observed in several countries. This discrepancy is not well understood.

OBJECTIVES

In this study, our aim was to discuss factors [ultraviolet radiation (UVR) exposure, melanoma treatment, diagnostic activity, overdiagnosis, pathologists' diagnostic threshold and clinicians' propensity to remove suspect skin lesions] that might influence melanoma incidence and mortality in Denmark.

METHODS

This was a register study with the number of melanocyte-related lesions and melanoma mortality based on comprehensive national pathology and mortality databases for the period 1999-2019. We investigated melanocyte-related diagnoses and mortality in a population of 5.5 million with a national healthcare system. Age-adjusted melanoma mortality and age-adjusted incidence of benign naevi, atypical lesion, or melanoma in situ and of invasive melanoma were computed for data analysis.

RESULTS

In total, 1 434 798 biopsies were taken from 704 682 individuals (65% female). The mean age at biopsy was 39.8 years in males and 37.6 in females. In males and females, the incidence of invasive melanoma increased by 87% during the period 1999-2011. During the subsequent period it increased by 9% in males but remained unchanged in females. The incidence of melanoma in situ increased by 476% in males and 357% in females during the study period, while the increases for atypical melanocytic lesions were 1928% and 1686%, respectively. Biopsy rates increased by 153% in males and 118% in females from 1999 through 2011 but fell by 20% in males and 22% in females during the subsequent period. Mortality varied slightly from year to year without any significant time trend for males or females. We identified no evidence of increased UVR exposure over the latest 30 years in Denmark. Immunotherapy of advanced melanoma was introduced in Denmark in 2010 and came into general use in 2014.

CONCLUSIONS

Comprehensive national data demonstrate increasing melanoma incidence correlated with increasing biopsy rates, but with no change in mortality. Previously suggested explanations for such a trend are a lowered threshold of melanoma diagnosis among pathologists, increased diagnostic activity in the presence of overdiagnosis and improved melanoma treatment. Because the study is observational and we have more explanatory factors than outcomes, the findings do not warrant conclusions about causal relationships.

A signature of seven hypoxia-related lncRNAs is a potential biomarker for predicting the prognosis of melanoma

Melanoma is the most aggressive type of skin cancer and has a high mortality rate once metastasis occurs. Hypoxia is a universal characteristic of the microenvironment of cancer and a driver of melanoma progression. In recent years, long noncoding RNAs (lncRNAs) have attracted widespread attention in oncology research. In this study, screening was performed and revealed seven hypoxia-related lncRNAs AC008687.3, AC009495.1, AC245128.3, AL512363.1, LINC00518, LINC02416 and MCCC1-AS1 as predictive biomarkers. A predictive risk model was constructed via univariate Cox regression analysis, least absolute shrinkage and selection operator (LASSO), and multivariate Cox regression analyses. Patients were grouped according to the model risk score, and Kaplan-Meier analysis was performed to compare survival between groups. Functional and pathway enrichment analyses were performed to compare gene set enrichment between groups. Moreover, a nomogram was constructed with the risk score as a variable. In both the training and validation sets, patients in the low-risk group had better overall survival than did those in the high-risk group (P<0.001). The 3-, 5- and 10-year area under the curve (AUC) values for the nomogram model were 0.821, 0.795 and 0.820, respectively. Analyses of immune checkpoints, immunotherapy response, drug sensitivity, and mutation landscape were also performed. The results suggested that the low-risk group had a better response to immunotherapeutic. In addition, the nomogram can effectively predict the prognosis and immunotherapy response of melanoma patients. The signature of seven hypoxia-related lncRNAs showed great potential value as an immunotherapy response biomarker, and these lncRNAs might be treatment targets for melanoma patients.

Plasmid co-expressing siRNA-PD-1 and Endostatin carried by attenuated Salmonella enhanced the anti-melanoma effect via inhibiting the expression of PD-1 and VEGF on tumor-bearing mice

Melanoma, the most perilous form of skin cancer, is known for its inherent resistance to chemotherapy. Even with advances in tumor immunotherapy, the survival of patients with advanced or recurrent melanomas remains poor. Over time, melanoma tumor cells may produce excessive angiogenic factors, necessitating the use of combinations of angiogenesis inhibitors, including broad-spectrum options, to combat melanoma. Among these inhibitors, Endostatin is one of the most broad-spectrum and least toxic angiogenesis inhibitors. We found Endostatin significantly increased the infiltration of CD8+ T cells and reduced the infiltration of M2 tumor-associated macrophages (TAMs) in the melanoma tumor microenvironment (TME). Interestingly, we also observed high expression levels of programmed death 1 (PD-1), an essential immune checkpoint molecule associated with tumor immune evasion, within the melanoma tumor microenvironment despite the use of Endostatin. To address this issue, we investigated the effects of a plasmid expressing Endostatin and PD-1 siRNA, wherein Endostatin was overexpressed while RNA interference (RNAi) targeted PD-1. These therapeutic agents were delivered using attenuated Salmonella in melanoma-bearing mice. Our results demonstrate that pEndostatin-siRNA-PD-1 therapy exhibits optimal therapeutic efficacy against melanoma. We found that pEndostatin-siRNA-PD-1 therapy promotes the infiltration of CD8+ T cells and the expression of granzyme B in melanoma tumors. Importantly, combined inhibition of angiogenesis and PD-1 significantly suppresses melanoma tumor progression compared with the inhibition of angiogenesis or PD-1 alone. Based on these findings, our study suggests that combining PD-1 inhibition with angiogenesis inhibitors holds promise as a clinical strategy for the treatment of melanoma.

Molecular Imaging of Melanoma VEGF-expressing Tumors through [99mTc]Tc-HYNIC-Fab(Bevacizumab)

BACKGROUND

Angiogenesis is a process that many tumors depend on for growth, development, and metastasis. Vascular endothelial growth factor (VEGF) is one of the major players in tumor angiogenesis in several tumor types, including melanoma. VEGF inhibition is achieved by bevacizumab, a humanized monoclonal antibody that binds with high affinity to VEGF and prevents its function. In order to successfully enable in vivo VEGF expression imaging in a murine melanoma model, we previously labeled bevacizumab with [99mTc]Tc. We observed that this was feasible, but it had prolonged blood circulation and delayed tumor uptake.

OBJECTIVE

The aim of this study was to develop a radiolabeled Fab bevacizumab fragment, [99mTc]Tc-HYNICFab( bevacizumab), for non-invasive in vivo VEGF expression molecular imaging.

METHODS

Flow cytometry was used to examine VEGF presence in the murine melanoma cell line (B16-F10). Bevacizumab was digested with papain for six hours at 37°C to produce Fab(bevacizumab), which was then conjugated to NHS-HYNIC-Tfa for radiolabeling with [99mTc]Tc. Stability and binding affinity assays were also evaluated. Biodistribution and single photon emission computed tomography/computed tomography (SPECT/CT) were performed at 1, 3, and 6 h (n = 4) after injection of [99mTc]Tc-HYNIC-Fab(Bevacizumab) in normal and B16-F10 tumor-bearing C57Bl/6J mice.

RESULTS

Using flow cytometry, it was shown that the B16-F10 murine melanoma cell line has intracellular VEGF expression. Papain incubation resulted in the complete digestion of bevacizumab with good purity and homogeneity. The radiolabeling yield of [99mTc]Tc-HYNIC-Fab(bevacizumab) was 85.00 ± 6.06%, with a specific activity of 291.87 ± 18.84 MBq/mg (n=3), showing in vitro stability. Binding assays demonstrated significant intracellular in vitro VEGF expression. Fast blood clearance and high kidney and tumor uptake were observed in biodistribution and SPECT/CT studies.

CONCLUSIONS

We present the development and evaluation of [99mTc]Tc-HYNIC-Fab(bevacizumab), a novel molecular VEGF expression imaging agent that may be used for precision medicine in melanoma and potentially in other VEGF-expressing tumors.

The effects of exposure to solar radiation on human health

This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.

Enhancing Skin Cancer Immunotheranostics and Precision Medicine through Functionalized Nanomodulators and Nanosensors: Recent Development and Prospects

Skin cancers, especially melanomas, present a formidable diagnostic and therapeutic challenge to the scientific community. Currently, the incidence of melanomas shows a high increase worldwide. Traditional therapeutics are limited to stalling or reversing malignant proliferation, increased metastasis, or rapid recurrence. Nonetheless, the advent of immunotherapy has led to a paradigm shift in treating skin cancers. Many state-of-art immunotherapeutic techniques, namely, active vaccination, chimeric antigen receptors, adoptive T-cell transfer, and immune checkpoint blockers, have achieved a considerable increase in survival rates. Despite its promising outcomes, current immunotherapy is still limited in its efficacy. Newer modalities are now being explored, and significant progress is made by integrating cancer immunotherapy with modular nanotechnology platforms to enhance its therapeutic efficacy and diagnostics. Research on targeting skin cancers with nanomaterial-based techniques has been much more recent than other cancers. Current investigations using nanomaterial-mediated targeting of nonmelanoma and melanoma cancers are directed at augmenting drug delivery and immunomodulation of skin cancers to induce a robust anticancer response and minimize toxic effects. Many novel nanomaterial formulations are being discovered, and clinical trials are underway to explore their efficacy in targeting skin cancers through functionalization or drug encapsulation. The focus of this review rivets on theranostic nanomaterials that can modulate immune mechanisms toward protective, therapeutic, or diagnostic approaches for skin cancers. The recent breakthroughs in nanomaterial-based immunotherapeutic modulation of skin cancer types and diagnostic potentials in personalized immunotherapies are discussed.

Prognostic value of genetic aberrations and tumor immune microenvironment in primary acral melanoma

BACKGROUND

Acral melanoma (AM) is the most common subtype in Chinese melanoma patients with a very poor prognosis. However, our understanding of the disease pathogenesis and molecular landscape is limited by the few studies that have been conducted. Here, we profiled the clinical characteristics, mutational landscapes and tumor immune microenvironment of AM patients to gain insights into disease characteristics and potential treatment strategies.

METHODS

A total of 90 AM patients were enrolled and their tissue samples were subjected to next-generation sequencing and multiplexed immunohistochemistry tests. Kaplan-Meier curves and log-rank tests were used to analyze the prognostic potential of various genetic aberrations and immune cell compositions in AM.

RESULTS

The median disease-free survival was 21.3 months and estimated median overall survival (OS) was 60 months. More advanced stages, older ages and thickness of greater than 4 mm were associated with worse prognosis in AM patients (HR = 2.57, 95% CI 1.25-5.29, p = 0.01; HR = 2.77, 95% CI 1.22-6.28, p = 0.02; HR = 3.43, 95% CI 1.51-7.82, p < 0.01, respectively), while patients who received post-surgical treatments had better survival (HR = 0.36, 95% CI 0.17-0.76, p = 0.01). The most frequently altered genes included BRAF (14.5%), KIT (16.9%), NRAS (12%), NF1 (10.8%), APC (7.2%), and ARID2 (6%). Copy number variations (CNV) were commonly found in CCND1 (19.3%), CDK4 (19.3%), MDM2 (14.5%) and FGF19 (12%). CDK4 amplifications was independently associated with shorter OS in AM patients (HR = 3.61, 95% CI 1.38-9.46, p = 0.01). CD8 ⁺ T cells (p < 0.001) and M1 macrophages (p = 0.05) were more highly enriched in the invasive margin than in the tumor center. Patients with higher levels of M1 macrophage infiltration in the invasive margin derived markedly longer OS (HR = 0.43, 95% CI 0.20-0.95, p = 0.03). Interestingly, in CDK4-amplified patients, there tended to be a low level of M1 macrophage infiltration in the invasive margin (p = 0.06), which likely explains the poor prognosis in such patients.

CONCLUSIONS

Our study provided a comprehensive portrait of the clinicopathological features, genetic aberrations and tumor microenvironment profiles in AM patients and identified candidate prognostic factors, which may facilitate development of additional therapeutic options and better inform clinical management of AM patients. Based on these prognostic factors, further studies should focus on enhancing the infiltration of M1 macrophages, especially in CDK4-amplified AM patients.

Trends in the Burden of COPD Attributable to Ambient PM2.5 Exposure in China 1990-2019: An Age-Period-Cohort Analysis

OBJECTIVE

Exposure to ambient particulate matter (PM2.5) is the leading risk factor for developing chronic obstructive pulmonary disease (COPD) in China. The present study aimed to investigate the trends in COPD mortality attributable to ambient PM2.5 exposure in China from 1990 to 2019.

METHODS

Data on COPD burden attributable to ambient PM2.5 exposure in China were extracted from the Global Burden of Disease (GBD) study 2019. The estimated annual percentage change (EAPC) was used to assess COPD mortality from 1990 to 2019. The APC model was used to analyze the temporal trends in the rate of COPD mortality attributable to ambient PM2.5 exposure according to age, period, and cohort.

RESULTS

Exposure to ambient PM2.5 contributed to 192.4 thousand deaths in 1990 and 263.6 thousand deaths in 2019. The age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life year rate (ASDR) due to ambient PM2.5 exposure showed a gradual downward trend, the ASMR and ASDR in 2019 decreased to 16.6 per 100,000 with an EAPC of -2.82 (95% CI: -8.61 to 3.34) and 278.6 per 100,000 with an EAPC of -2.02 (95% CI: -7.85 to 4.19), compared to those in 1990, respectively. The relative risk (RR) of COPD increased with age in females, while in males, mortality significantly increased from the levels among those in the 60-64 age group to that among those in the 90-94 age group. In the period group, the RR of COPD in males remained above 1.0 from the 2000 to 2004 period, but it gradually decreased in females. The cohort effect showed an overall downward trend.

CONCLUSION

Although the ASMR and ASDR are decreasing in Chinese patients with COPD, the number of deaths due to COPD is increasing. Ambient PM2.5 exposure is more harmful in males and older people above 60 years of age.

Entrectinib for NTRK Fusion-Positive Metastatic Melanoma Progressing on Combined PD-1 and CTLA-4 Inhibition: A Case Report

Introduction

The burden of melanoma is increasing globally. Despite the use of immunotherapy and targeted therapy, the prognosis of metastatic melanoma remains relatively poor. The integration of comprehensive molecular profiling can lead to the detection of actionable biomarkers and the expansion of treatment options, thereby prolonging cancer patient survival.

Case Presentation

We herein present the case of a female 54-year-old patient diagnosed with melanoma of the right knee, for which she underwent surgery. Patient showed progression of disease after 10 cycles of adjuvant nivolumab. Ipilimumab (1 mg/kg every 3 weeks) was added to the treatment regimen but no clinical improvement was observed. Molecular profiling was conducted based on patient tissue, and an ANXA2-NTRK3 fusion was detected in the tumor. This specific fusion has not been previously reported; however, it is in-frame and similar to other known oncogenic NTRK fusions. At the time of entrectinib initiation, the patient had clear disease progression on the right leg on standard of care immunotherapy. She was commenced on entrectinib 200 mg once daily for 2 weeks. Dose escalation was attempted, and treatment intensity was managed based on drug tolerability. Good treatment response was observed on laboratory and radiologic parameters. As of September 2023, i.e., 2.5 years after treatment initiation, patient disease continues to be controlled with entrectinib.

Conclusion

Profiling of advanced tumors is important to determine the presence of agnostic markers that can be targeted and ultimately improve the prognostic outcome of patients after the failure of standard of care.

The role of angiogenesis in melanoma: Clinical treatments and future expectations

The incidence of melanoma has increased rapidly over the past few decades, with mortality accounting for more than 75% of all skin cancers. The high metastatic potential of Melanoma is an essential factor in its high mortality. Vascular angiogenic system has been proved to be crucial for the metastasis of melanoma. An in-depth understanding of angiogenesis will be of great benefit to melanoma treatment and may promote the development of melanoma therapies. This review summarizes the recent advances and challenges of anti-angiogenic agents, including monoclonal antibodies, tyrosine kinase inhibitors, human recombinant Endostatin, and traditional Chinese herbal medicine. We hope to provide a better understanding of the mechanisms, clinical research progress, and future research directions of melanoma.

The Emerging Burden of Genetic Instability and Mutation in Melanoma: Role of Molecular Mechanisms

Melanoma is a severe skin cancer affecting thousands of people and a growing public health concern worldwide. The potential hallmarks of melanoma are genetic instability and mutation (GIAM), which are driving mechanisms for phenotypic variation and adaptation in melanoma. In metastatic melanoma, DNA repair-associated genes are frequently expressed at higher levels than in primary cancers, suggesting melanoma cells rely on genetic stability to spread distantly. The tumour microenvironment is affected by genomic instability and melanoma mutation (GIMM), which plays significant roles in developing GIMM and their contributions to the overall disease burden. The GIAM is the crucial vulnerability of cancer cells, determining their sensitivity to harmful treatments, including radiation and many chemotherapeutics. The high incidence of melanoma is typically associated with genetic modifications, and several clinical and genetic interventions have been critical in easing the burden.

Melanoma of the Scalp and Neck: A Population-Based Analysis of Survival and Treatment Patterns

Introduction: Melanoma is an aggressive skin cancer. Large demographic and clinic-pathologic studies are required to identify variations of tumour behavior. The aim of our study was to offer updated epidemiologic data on the scalp and neck melanoma with an overall survival analysis. Method: The SEER database was searched for all scalp and neck melanoma in adult patients between 2000 and 2019. Demographic and clinic-pathologic variables were described. Their impact on overall survival was assessed with the log-rank test after Kaplan−Meier model. A multivariable cox-regression was conducted to identify predictors of decreased survival. A p-value of <0.005 was considered statistically significant. Results: 20,728 Melanomas of the scalp and neck were identified. Mean age was 62.5 years. Gender ratio was 76.3% males. 79% of the tumours were localized at diagnosis. Increasing age, male gender, tumour ulceration, high mitotic rate or nodular subtype were independent prognostic factors of decreased overall survival. Surgery with less than 1 cm margin is associated with the best overall survival in this cohort. No significant difference in OS was seen between less than 1 cm and 1 to 2 cm margins. Conclusion: Knowledge of negative prognostic factors might help identify subgroups at risk and adapt their oncologic treatment.

Spatiotemporal trends of disease burden of edentulism from 1990 to 2019: A global, regional, and national analysis

Background

Understanding the spatiotemporal trends in disease burden of edentulism is critical to reducing disease burden of edentulism and deploying medical resources. We assessed the changing patterns of disease burden of edentulism at global, regional, and national levels from 1990 to 2019.

Methods

Data on incident cases, prevalent cases, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of edentulism were extracted from the Global Burden of Disease 2019 Study. We calculated the estimated annual percentage change (EAPC) to quantify spatiotemporal trends in the ASRs of edentulism.

Results

In 2019, the number of prevalent cases and DALYs of edentulism were 35.2 and 9.6 million, and the ASPR and ASDR were 43.12/1,000 and 1.18/1,000, with EAPCs of -0.18 [95% confidence interval (CI): -0.28, -0.09] and -0.16[95% CI: -0.26, -0.07] from 1990 to 2019, respectively. Females and the elderly had a higher burden of edentulism. Although the ASPR, ASDR, and ASIR in the high SDI, high-middle SDI, and middle SDI regions showed a decreasing or stable trend, the absolute disease burdens of edentulism in these regions were still high. Although the absolute disease burdens of low SDI and low-middle SDI were low, their ASPR and ASDR showed an upward trend. In countries with high initial disease burden or high SDI, ASPR, ASDR, and ASIR showed stable or declining trends.

Conclusion

The absolute disease burden due to edentulism was increasing in many countries and regions. Countries should reduce the disease burden caused by edentulism by adopting measures including the prevention and treatment of dental caries and periodontal disease.

Trilayer dissolving polymeric microneedle array loading Rose Bengal transfersomes as a novel adjuvant in early-stage cutaneous melanoma management

Melanoma remains a global concern, but current therapies present critical limitations pointing out the urgent need for novel strategies. Among these, the cutaneous delivery of drugs selectively damaging cancer cells is highly attractive. Rose Bengal (RB) is a dye exhibiting selective cytotoxicity towards melanoma, but the high water solubility and low permeability hinder its therapeutic potential. We previously developed RB-loaded transfersomes (RBTF) to mediate the RB dermal delivery; however, a platform efficiently delivering RBTF in the deepest strata is essential for a successful therapeutic activity. In this regard, dissolving microneedles release the encapsulated cargo up to the dermis, painlessly piercing the outmost skin layers. Therefore, herein we developed and characterised a trilayer dissolving microneedle array (RBTF-TDMNs) loading RBTF to maximise RBTF intradermal delivery in melanoma management. RBTF-TDMNs were proven strong enough to pierce excised porcine skin and rapidly dissolve and deposit RBTF intradermally while maintaining their physicochemical properties. Also, 3D visualisation of the system itself and while penetrating the skin was performed by multi-photon microscopy. Finally, a dermatokinetic study showed that RBTF-TDMNs offered unique delivery efficiency advantages compared to RBTF dispersion and free drug-loaded TDMNs. The proposed RBTF-TDMNs represent a valuable potential adjuvant tool for the topical management of melanoma.

Global magnitude and temporal trend of mesothelioma burden along with the contribution of occupational asbestos exposure in 204 countries and territories from 1990 to 2019: Results from the Global Burden of Disease Study 2019

Understanding the burden of mesothelioma with the contribution of occupational asbestos exposure globally provides essential foundations for cancer control, policy decisions and resource allocation. Globally, 34,511 incident cases, 29,251 deaths and 668,104 disability-adjusted life years (DALYs) of mesothelioma were estimated in 2019. The age-standardized rates of incidence, mortality and DALYs all showed a slightly declining trend over the past 30 years, but the latest absolute number of mesothelioma burden almost doubled since 1990. The burden rate decreased among the population aged under 70 years, but increased among the population aged over 80 years, especially in the High socio-demographic index (SDI) region. The burden rate of mesothelioma attributable to asbestos exposure was positively associated with SDI at the national level. This study depicted a continuous increase in mesothelioma burden globally over the past 30 years. Controlling occupational asbestos exposure will reduce the mesothelioma burden, especially for higher SDI regions.

Management of cutaneous melanoma: radiologists challenging and risk assessment

Melanoma patient remains a challenging for the radiologist, due to the difficulty related to the management of a patient more often in an advanced stage of the disease. It is necessary to determine a stratification of risk, optimizing the means, with diagnostic tools that should be optimized in relation to the type of patient, and improving knowledge. Staging and risk assessment procedures are determined by disease presentation at diagnosis. Melanoma staging is a critical tool to assist clinical decision-making and prognostic assessment. It is used for clinical trial design, eligibility, stratification, and analysis. The current standard for regional lymph nodes staging is represented by the sentinel lymph node excision biopsy procedure. For staging of distant metastases, PET-CT has the highest sensitivity and diagnostic odds ratio. Similar trend is observed during melanoma surveillance. The advent of immunotherapy, which has improved patient outcome, however, has determined new issues for radiologists, partly due to atypical response patterns, partly due to adverse reactions that must be identified as soon as possible for the correct management of the patient. The main objectives of the new ir-criteria are to standardize the assessment between different trials. However, these ir-criteria do not take into account all cases of atypical response patterns, as hyperprogression or dissociated responses. None of these criteria has actually been uniformly adopted in routine. The immune-related adverse events (irAEs) can involve various organs from head to toe. It is crucial for radiologists to know the imaging appearances of this condition, to exclude recurrent or progressive disease and for pneumonitis, since it could be potentially life-threatening toxicity, resulting in pneumonitis-related deaths in early phase trials, to allow a proper patient management.

Expression Patterns of Necroptosis-Related Genes: Predicting Prognosis and Immunotherapeutic Effects in Cutaneous Melanoma

Background

Increasing evidence has shown a strong correlation between necroptosis and antitumor immunity. However, precise expression patterns of necroptosis-related genes in cutaneous melanoma (CM) have not been clearly elucidated nor have their effects on the immune cell infiltration in the tumor microenvironment.

Method

We investigated the expression patterns of necroptosis-related genes of individuals with cutaneous melanoma based on 67 necroptotic genes and methodically associated the expression patterns with the comprehensive characterization of tumor immune microenvironment. Using principal component analysis methods, the NRG score was developed to quantify the expression patterns of necroptotic genes in CM patients.

Result

Three different necroptotic subtypes were determined with marked survival differences, showing distinct characteristics of immune cell infiltration. The high NRG score group with comprehensive immunosuppression was characterized by the worse immunotherapeutic efficacy and the poor prognosis, while the low NRG score group indicated a robust activation of immune function and a better response to immunotherapy, which may be responsible for a better prognosis. Furthermore, the predictive ability of the NRG score on prognosis and immunotherapeutic benefits was further revalidated using the other independent datasets of cutaneous melanoma. The results indicated that patients with low NRG scores exhibited prolonged survival. Surprisingly, all patients with CM with clinical response, including complete response/partial response, belonged to the low NRG score group.

Conclusion

Our present work revealed the close association between expression patterns of necroptosis-associated genes and tumor immune microenvironment. NRG score can serve as a potential predictor to independently assess patients' prognosis with CM and effectively estimate the response to immunological therapy, thus facilitating the identification of appropriate candidates with CM for immunotherapy and the formulation of individualized therapeutic approaches.

Value of a Signature of Immune-Related Genes in Predicting the Prognosis of Melanoma and Its Responses to Immune Checkpoint Blocker Therapies

Melanoma is becoming increasingly common worldwide, with high rates of transformation into malignancy compared to other skin lesions. The prognosis of patients with melanoma at an advanced stage is highly unsatisfying despite the development of immunotherapy, target therapy, or combinative therapy. The major barrier to exploiting immune checkpoint therapies and achieving the best benefits clinically is resistance that can easily develop if regimens are not selected appropriately. In this study, we investigated the possibility of using immune-related genes to predict patient survival and their responses to immune checkpoint blocker therapies with the expression profiles available at The Cancer Genome Atlas (TCGA) Program plus expression data from the Gene Expression Omnibus (GEO) for validation. A five gene signature that is highly correlated with the local infiltration of cytotoxic lymphocytes in the tumor microenvironment was identified, and a scoring model was developed with stepwise regression after multivariate Cox analyses. The score calculated strongly correlates with Breslow depth, and this model effectively predicts the prognosis of patients with melanoma, whether primary or metastasized. It also depicts the heterogenous immune-related nature of melanoma by revealing different predicted responses to immune checkpoint blocker therapies through its correlation to tumor immune dysfunction and exclusion (TIDE) score.

Multi-Intensity Optimization-Based CT and Cone Beam CT Image Registration

Cancer is a highly lethal disease that is mainly treated by image-guided radiotherapy. Because the low dose of cone beam CT is less harmful to patients, cone beam CT images are often used for target delineation in image-guided radiotherapy of various cancers, especially in breast and lung cancer. However, breathing and heartbeat can cause position errors in images taken during different periods, and the low dose of cone beam CT also results in insufficient imaging clarity, rendering existing registration methods unable to meet the CT and cone beam CT registration tasks. In this paper, we propose a novel multi-intensity optimization-based CT and cone beam CT registration method. First, we use a multi-weighted mean curvature filtering algorithm to preserve the multi-intensity details of the input image pairs. Then, the strong edge retention results are registered using and intensity-based method to obtain the multi-intensity registration results. Next, a novel evaluation method called intersection mutual information is proposed to evaluate the registration accuracy of the different multi-intensity registration results. Finally, we determine the optimal registration transformation by intersection mutual information and apply it to the input image pairs to obtain the final registration results. The experimental results demonstrate the excellent performance of the proposed method, meeting the requirements of image-guided radiotherapy.

The Dark Side of Melanin Secretion in Cutaneous Melanoma Aggressiveness

Skin cancers are among the most common cancers worldwide and are increasingly prevalent. Cutaneous melanoma (CM) is characterized by the malignant transformation of melanocytes in the epidermis. Although CM shows lower incidence than other skin cancers, it is the most aggressive and responsible for the vast majority of skin cancer-related deaths. Indeed, 75% of patients present with invasive or metastatic tumors, even after surgical excision. In CM, the photoprotective pigment melanin, which is produced by melanocytes, plays a central role in the pathology of the disease. Melanin absorbs ultraviolet radiation and scavenges reactive oxygen/nitrogen species (ROS/RNS) resulting from the radiation exposure. However, the scavenged ROS/RNS modify melanin and lead to the induction of signature DNA damage in CM cells, namely cyclobutane pyrimidine dimers, which are known to promote CM immortalization and carcinogenesis. Despite triggering the malignant transformation of melanocytes and promoting initial tumor growth, the presence of melanin inside CM cells is described to negatively regulate their invasiveness by increasing cell stiffness and reducing elasticity. Emerging evidence also indicates that melanin secreted from CM cells is required for the immunomodulation of tumor microenvironment. Indeed, melanin transforms dermal fibroblasts in cancer-associated fibroblasts, suppresses the immune system and promotes tumor angiogenesis, thus sustaining CM progression and metastasis. Here, we review the current knowledge on the role of melanin secretion in CM aggressiveness and the molecular machinery involved, as well as the impact in tumor microenvironment and immune responses. A better understanding of this role and the molecular players involved could enable the modulation of melanin secretion to become a therapeutic strategy to impair CM invasion and metastasis and, hence, reduce the burden of CM-associated deaths.

Deep Learning Methods for Accurate Skin Cancer Recognition and Mobile Application

Although many efforts have been made through past years, skin cancer recognition from medical images is still an active area of research aiming at more accurate results. Many efforts have been made in recent years based on deep learning neural networks. Only a few, however, are based on a single deep learning model and targeted to create a mobile application. Contributing to both efforts, first we present a summary of the required medical knowledge on skin cancer, followed by an extensive summary of the most recent related works. Afterwards, we present 11 CNN (convolutional neural network) candidate single architectures. We train and test those 11 CNN architectures, using the HAM10000 dataset, concerning seven skin lesion classes. To face the imbalance problem and the high similarity between images of some skin lesions, we apply data augmentation (during training), transfer learning and fine-tuning. From the 11 CNN architecture configurations, DenseNet169 produced the best results. It achieved an accuracy of 92.25%, a recall (sensitivity) of 93.59% and an F1-score of 93.27%, which outperforms existing state-of-the-art efforts. We used a light version of DenseNet169 in constructing a mobile android application, which was mapped as a two-class model (benign or malignant). A picture is taken via the mobile device camera, and after manual cropping, it is classified into benign or malignant type. The application can also inform the user about the allowed sun exposition time based on the current UV radiation degree, the phototype of the user’s skin and the degree of the used sunscreen. In conclusion, we achieved state-of-the-art results in skin cancer recognition based on a single, relatively light deep learning model, which we also used in a mobile application.