Associations of non-melanoma skin cancer and melanoma, extra-cutaneous cancers and smoking in adults: a US population-based study

Characteristics of patients with melanoma with non‑melanoma skin cancer comorbidity: Practical implications based on a retrospective study

The co-occurrence of melanoma and non-melanoma skin cancer (NMSC) can lead to increased morbidity. However, there has been limited research into the dermoscopic characteristics of melanomas and clinical factors during co-occurrence. A total of 264 patients with melanoma, including 63 with NMSC comorbidity, were enrolled in the present study to retrospectively analyse the coexistence of melanoma morphology, as determined by dermoscopic examination, pathological report, tumour location and clinically manifested risk factors. The frequency of solar lentiginosis (SL) was compared between 264 patients with melanoma and 233 patients with NMSC without melanoma. In 83.4% of cases, skin cancer occurred before or concomitantly with the melanoma. The leading indicators of comorbidity were age (median 70 years; P<0.0001) and SL on the trunk and arms (P<0.0001). Melanomas in patients with NMSC comorbidity were significantly more frequently located on the head and neck [P<0.001; Bonferroni adjusted P-value (P-adj.)<0.01], then on the trunk, but less frequently occurred on the lower limbs (P<0.05). The dermoscopic multicomponent asymmetric pattern was the predominant pattern in both groups. The most characteristic pattern in the NMSC group was facial melanoma (P<0.005; P-adj.<0.05); the spitzoid pattern (P<0.001; P-adj.<0.01) was rare. Dermoscopic regression was more common (P<0.001) in the NMSC group. Regression and the number of nevi were independent of age. Differences in the incidence of SL were evaluated based on the presence of melanoma (P<0.01) and in patients without melanoma based on the presence of squamous cell carcinoma (SCC; P<0.01), multiple basal cell carcinoma (P<0.0001) and multiple SCC (P<0.005). Patients with melanoma were 10 years younger on average compared with patients with NMSC (P<0.0001). The differentiation factors identified in the present study may improve the precision of dermoscopic examinations and potentially lead to modifications in the diagnostic workflow for patients with multiple NMSCs with comorbid melanoma.

Spectrum of malignant and premalignant skin lesions in 505 adult subjects at risk of skin cancers

Patients at risk of skin cancers can develop varying types of cutaneous malignancies. However, some subjects may develop only one type of lesion. In this cross-sectional study, the spectrum of premalignant (PM) and malignant skin lesions and their risk factors were studied. Therefore, 505 adult subjects (aged 21-79 years, 256 males and 249 females, 96 with immunosuppression) at risk of any type of skin cancer were examined for cutaneous malignancies, nevi, actinic keratoses, photodamage, and possible risk factors. First, 12 different groups were identified with a varying set of PM and/or malignant skin lesions. Next, 5 larger groups were formed from them: basal cell carcinoma (BCC) only, malignant melanoma (MM) only, squamous cell carcinoma (SCC) and/or PM, BCC + SCC and/or PM, and MM + keratinocyte carcinoma (KC) and/or PM. The groups with BCC or MM only were younger and showed less photodamage than the mixed groups, while SCC/PM showed similarity with them. In logistic regression analyses, the platelet-to-lymphocyte ratio was associated with an increased risk of concomitant KC (OR 1.028, p = 0.023) or SCC/PM (OR 1.009, p = 0.047) in subjects with MM or BCC, respectively. Actinic keratoses produced ORs 0.246-0.252 (p = 0.008-0.020) for BCC in subjects with SCC/PM. Interestingly, atypical mole syndrome decreased the risk of SCC/PM in subjects with BCC (OR 0.092, p = 0.001). Advanced age was a significant risk factor for an additional type of lesion in all 3 comparisons (ORs 1.088-1.388, p = 0.001). In conclusion, even though there are numerous patients with only one lesion type, advancing age may determine the final lesion multiplicity.

Temporal correlation between the first melanoma and the first noncutaneous tumor in CKDN2A genotyped patients

CDKN2A pathogenic variants are well known to be associated with cutaneous melanoma and noncutaneous tumors (NCTs). Herein, we investigated the temporal correlation between the first cutaneous melanoma and NCT both in CDKN2A mutation carriers (MUT) and in wild-type melanoma patients, a poorly explored issue to date. Two hundred forty-five cutaneous melanoma patients were genotyped for the CDKN2A gene and divided into 51 MUT and 189 wild-type; the remaining five variant carriers were excluded from the analyses. MUT developed a significantly higher number of cutaneous melanoma than wild-type, while 13.7% in both genotyped groups received a diagnosis of at least one malignant NCT, without statistically significant differences. The onset of the first cutaneous melanoma preceded that of the first malignant or benign NCT in both MUT and wild-type patients by an average of 4.5 and 3.02 years, respectively. Considering only malignant tumors, the diagnosis of melanoma preceded that of the first NCT on an average of 8 and 4.34 years, in MUT and wild-type patients respectively. We emphasize the relevance to adopt a global vision for the primary and secondary surveillance of patients affected by cutaneous melanoma, not only limited to high-risk for multiple primary skin cancers but also to NCT that may develop several years after the diagnosis of the first cutaneous melanoma.

Influence of the Exposome on Skin Cancer

Skin cancer is the most frequent type of cancer in humans. While exposure to solar radiation is the most widely known and relevant causal factor, the different degrees of individual risk have not been fully elucidated. Epidemiological studies show how the risk of skin cancer is affected by other types of radiation (eg, ionizing radiation), pesticides, particulate matter in air pollution, toxins (eg, arsenic) in water and some foods. Some living entities, such as polyomavirus and human papillomavirus, can also cause specific types of cancer. Lastly, lifestyle factors such as stress, sleep, and exercise may play a role, although only a few studies shed light on these factors. The abovementioned factors make up the exposome of skin cancer, that is, the set of environmental exposures that, together with the genome and microbiome, determine the onset of disease.

LINC0638 lncRNA is involved in the local recurrence of melanoma following surgical resection

Melanoma is a rare malignancy in China and the treatment outcomes are generally satisfactory. However, postoperative recurrence can be life-threatening. The current study aimed to investigate the involvement of long intergenic non-protein coding RNA 1638 (LINC01638) long non-coding RNA (lncRNA) in the recurrence of melanoma. Expression of LINC01638 lncRNA in skin biopsies and plasma of patients with melanoma, patients with benign skin lesions and healthy controls was detected by reverse transcription-quantitative polymerase chain reaction. Diagnostic values of LINC01638 lncRNA for melanoma were analyzed by receiver operating characteristic curve analysis. The association between LINC01638 lncRNA and clinicopathological data of patients with melanoma was analyzed by χ² test. All patients were followed up for five years to record recurrence. LINC01638 lncRNA expression vectors and shRNAs were transfected into human melanoma cell lines and the effects of LINC01638 lncRNA overexpression and knockdown on cell proliferation were analyzed by cell counting kit-8 assay. LINC01638 lncRNA was significantly upregulated in patients with melanoma compared with the other two groups of patients, and upregulation of LINC01638 lncRNA distinguished patients with melanoma from patients with benign skin lesions and healthy controls. LINC01638 lncRNA expression was significantly associated with tumor size but not with other patient clinical data. Plasma levels of LINC01638 lncRNA were further increased during follow-up in patients with local recurrence but not in patients without recurrence. LINC01638 lncRNA overexpression promoted, while knockdown inhibited proliferation of cells of melanoma cell lines, C32 and SK-MEL-28, in vitro. The upregulation of LINC01638 lncRNA was likely associated with the local recurrence of melanoma following surgical resection.

Epidemiological and histopathological aspects of primary cutaneous melanoma in residents of Joinville, 2003-2014

BACKGROUND

The worldwide incidence of cutaneous melanoma (CM) has been continuously increasing over the last decades. Primary and secondary prevention, with attention to risk factors and early diagnosis, remain the cornerstone for reducing the burden of cutaneous melanoma. Detailed information with respect to clinical and pathological data on cutaneous melanoma is scarce in Brazil.

OBJECTIVE

The purpose of our study was to analyze epidemiological and pathological characteristics of primary cutaneous melanoma in Joinville, southern Brazil.

METHODS

Observational, cross-sectional, retrospective study in which 893 reports of primary cutaneous melanoma from the local population were analyzed in the period 2003-2014. The study was approved by the local Ethics and Research Committee.

RESULTS

We observed a female predominance of cutaneous melanoma (56.3%). The age standardized incidence rate of primary cutaneous melanoma for the world population in the period 2003-06 was 11.8 per 100,000 population (CI 95%, 10.3-13.4), and 17.5 (CI 95%, 15.7-19.3) in 2011-14, revealing a significant increase of 48.3% (p < 0,05). Six and a half percent of patients had multiple cutaneous melanomas (mean 2.2 years and a maximum of 10.0 years between diagnoses). We observed significant differences between the location head/neck and cutaneous melanoma in situ, lower limb with Breslow depth S III and upper limb with Breslow depth S I. The comparison of the characteristics of cutaneous melanoma in the elderly and non-elderly (< 60 years old) showed significant differences with respect to all the variables studied.

STUDY LIMITATIONS

Using secondary data source.

CONCLUSION

Joinville has high incidence coefficients for Brazilian standards, showing an increase in the incidence of cutaneous melanoma.

A case-control study on association of nucleotide excision repair polymorphisms and its interaction with environment factors with the susceptibility to non-melanoma skin cancer

Aims

To investigate the association of several single nucleotide polymorphisms (SNPs) within nucleotide excision repair (NER) gene and additional gene- gene and gene- smoking interaction with non-melanoma skin cancer (NMSC) risk in a Chinese population.

Methods

A total of 1322 participants (939 males, 383 females) were selected, including 660 NMSC patients and 662 control participants. Generalized multifactor dimensionality reduction (GMDR) was used to screen the best interaction combination among SNPs and smoking. Logistic regression was performed to investigate association between 4 SNPs within NER gene, additional gene- gene and gene- smoking interaction on NMSC risk.

Results

NMSC risk was significantly higher in carriers with G allele of rs2228527 than those with AA genotype (AG + GG versus AA), adjusted OR (95%CI) =1.76 (1.24-2.37), and higher in carriers with the G allele of rs2228529 than those with AA genotype (AG + GG versus AA), adjusted OR (95%CI) = 1.66 (1.24-2.13). However, we did not find any direct association of the rs4134822 and rs1799793 with NMSC risk after covariates adjustment. GMDR model indicated a significant interaction combination (p=0.0010), including rs2228529 and current smoking. Overall, the cross-validation consistency of this model was 9/ 10, and the testing accuracy was 60.72%. Current smokers with rs2228529- GA or GG genotype have the highest NMSC risk, compared to never- smokers with rs2228529- AA genotype, OR (95%CI) = 2.92 (1.61-4.29).

Conclusions

We found that the G allele of rs2228527 and the G allele of rs2228529 within NER gene, interaction between rs2228529 and current smoking were all associated with increased NMSC risk.

The association between ambient fine particulate matter and incident adenocarcinoma subtype of lung cancer

BACKGROUND

Adenocarcinoma (AC) is the most common lung cancer among non-smokers, but few studies have assessed the effect of PM_2.5 on AC among never smokers. The purpose of this study was to assess the association between ambient PM_2.5 and incident lung AC in the Adventist Health and Smog Study-2 (AHSMOG-2), a cohort of 80,044 non-smokers (81% never smokers) followed for 7.5 years (597,177 person-years) (2002-2011).

METHODS

Incident lung AC was identified through linkage with U.S. state cancer registries. Ambient PM_2.5 levels at subjects' residences were estimated for the years 2000 and 2001, immediately prior to study start.

RESULTS

A total of 164 incident lung AC occurred during follow-up. Each 10 μg/m³ increment in PM_2.5 was associated with an increase in the hazard rate of lung AC [HR = 1.31 (95% confidence interval (CI) 0.87-1.97)] in the single-pollutant model. Excluding those with prevalent non-melanoma skin cancer (NMSC) strengthened the association with lung AC (HR = 1.62 (95% CI, 1.11-2.36) for each 10 μg/m³ PM_2.5 increment. Also, limiting the analyses to subjects who spent more than 1 h/day outdoors, increased the estimate (HR = 1.55, 95% CI: 1.05, 2.30).

CONCLUSIONS

Increased risk of AC was observed for each 10 μg/m³ increment in ambient PM_2.5 concentrations. The risk was higher among those without prevalent NMSC and those who spent more than 1 h/day outdoors.