Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology

Skin Cancer Detection Using Deep Learning Approaches

Aim: This review examined multiple deep learning (DL) methods, including artificial neural networks (ANNs), convolutional neural networks (CNNs), k-nearest neighbors (KNNs), as well as generative adversarial networks (GANs), relying on their abilities to differentially extract key features for the identification and classification of skin lesions. Background: Skin cancer is among the most prevalent cancer types in humans and is associated with tremendous socioeconomic and psychological burdens for patients and caregivers alike. Incidences of skin cancers have progressively increased during the last decades. Early diagnoses of skin cancers may aid in the implementation of more effective treatment and therapeutic regimens. Indeed, several recent studies have focused on early detection strategies for skin cancer. Among the lesion features that can aid the recognition and characterization of skin cancers are symmetry, color, size, and shape. Results: Our assessment indicates that CNNs delivered maximum accuracy in visual lesion recognition, yet GANs have surfaced as a strong tool for training augmentation through simulated image creation. However, there were significant limitations associated with existing datasets, such as provision of insufficient skin tone variability, demanding computational needs, and unequal lesion representations, which may hamper efficiency, inclusivity, and generalizability of DL models. Researchers must combine diverse high-resolution datasets within a structural framework to develop efficient computational models with unsupervised learning methods to enhance noninvasive and precise skin cancer detection. Conclusion: The breakthroughs in image-based computational skin cancer detection may be crucial in reducing the requirement of invasive diagnostic tests and expanding the scope of skin cancer screening toward broad demographics, thereby aiding early cancer detection in a time- and cost-efficient manner.

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.

Automatic melanoma and non-melanoma skin cancer diagnosis using advanced adaptive fine-tuned convolution neural networks

Skin Cancer is an extensive and possibly dangerous disorder that requires early detection for effective treatment. Add specific global statistics on skin cancer prevalence and mortality to emphasize the importance of early detection. Example: "Skin cancer accounts for 1 in 5 diagnosed cancers globally, with melanoma causing over 60,000 deaths annually. Manual skin cancer screening is both time-intensive and expensive. Deep learning (DL) techniques have shown exceptional performance in various applications and have been applied to systematize skin cancer diagnosis. However, training DL models for skin cancer diagnosis is challenging due to limited available data and the risk of overfitting. Traditionally approaches have High computational costs, a lack of interpretability, deal with numerous hyperparameters and spatial variation have always been problems with machine learning (ML) and DL. An innovative method called adaptive learning has been developed to overcome these problems. In this research, we advise an intelligent computer-aided system for automatic skin cancer diagnosis using a two-stage transfer learning approach and Pre-trained Convolutional Neural Networks (CNNs). CNNs are well-suited for learning hierarchical features from images. Annotated skin cancer photographs are utilized to detect ROIs and reset the initial layer of the pre-trained CNN. The lower-level layers learn about the characteristics and patterns of lesions and unaffected areas by fine-tuning the model. To capture high-level, global features specific to skin cancer, we replace the fully connected (FC) layers, responsible for encoding such features, with a new FC layer based on principal component analysis (PCA). This unsupervised technique enables the mining of discriminative features from the skin cancer images, effectively mitigating overfitting concerns and letting the model adjust structural features of skin cancer images, facilitating effective detection of skin cancer features. The system shows great potential in facilitating the initial screening of skin cancer patients, empowering healthcare professionals to make timely decisions regarding patient referrals to dermatologists or specialists for further diagnosis and appropriate treatment. Our advanced adaptive fine-tuned CNN approach for automatic skin cancer diagnosis offers a valuable tool for efficient and accurate early detection. By leveraging DL and transfer learning techniques, the system has the possible to transform skin cancer diagnosis and improve patient outcomes.

Clinical-histological characteristics and therapeutic management of primary cutaneous melanoma in elderly patients

BACKGROUND

Life expectancy is rising in developed countries. The impact of age on melanoma characteristics is unclear, but it seems that melanomas in the elderly have distinct features affecting management and outcomes.

OBJECTIVES

To compare clinical and histopathological melanoma characteristics and management in elderly and younger patients.

METHODS

A retrospective population-based study analyzed melanomas observed between 2007 and 2022 was made in the southern Seville health area (Spain). Patients were divided into two age groups: <65 and ≥65. Data were collected from clinical histories.

RESULTS

Among 431 primary cutaneous melanomas, 33% were in patients ≥65-years. Elderly patients had more head and neck melanomas (37.8% vs. 14.9%; p < 0.001), larger lesions (1.3 vs. 0.9 cm; p < 0.001), more ulcerated melanomas (17.8% vs. 8.8%; p < 0.012), and higher Breslow thickness (1.03 vs. 0.65 mm; p < 0.01) than younger patients. No differences were found in the number of mitoses or histopathological invasions. Stage 0 and more advanced stages (II/III/IV) were observed more frequently in ≥65-years (29.3% vs. 23% and 27.1% vs. 15.7%, p < 0.001 respectively). Fewer wide excisions (28.4% vs. 5.6%, p < 0.001), sentinel lymph node biopsy (17.6% vs. 2.4%, p < 0.001), and adjuvant therapy (11.9% vs. 2.1%, p < 0.001) were performed in patients ≥65-years.

STUDY LIMITATIONS

The study was retrospective, primarily covering the last 10-years, with older data missing. Key risk factors like the number of nevi and family history of melanoma were not collected.

CONCLUSIONS

Melanomas in the elderly were diagnosed more frequently at initial and advanced stages despite having worse prognostic characteristics compared melanomas occurring in younger people.

Unsealed188 Rhenium Resin Brachytherapy in Non-Surgical Candidates With Refractory Basal Cell Carcinoma: Clinical Outcomes

INTRODUCTION

High-dose brachytherapy using a non-sealed 188Rhenium resin (188Re) is a new treatment option for difficult-to-treat basal cell carcinoma (BCC) that ensures a radical oncological outcome minimizing side effects.

OBJECTIVES

The aim of this retrospective study was to evaluate the clinical efficacy of high-dose standardized brachytherapy using an unsealed 188Re in the management of difficult-to-treat BCCs and to evaluate the risk factors of relapses.

METHODS

Between October 2017 and December 2022, patients affected by difficult-to-treat BCC were selected.

INCLUSION CRITERIA

histologically proven cutaneous BCC; thickness invasion no deeper than 3 mm; lesion located in the scalp, face, ears, or fingers or other areas in which surgery would have been difficult to perform or to destroy with scarce cosmetic-functional result; contraindication or refusal of surgery. All patients performed follow-up visits with videodermoscopy every 4-6 months.

RESULTS

Sixty-four consecutive patients affected by 82 histologically proven high-risk BCCs, were enrolled: 60 were nodular, 9 sclerodermiform, and 13 superficial. Average follow-up was 24 months. Brachytherapy with 188Re resin achieved a complete response in 93% of "difficult-to-treat" BCCs, with relapses occurring on average 24 months after the initial treatment. No statistically significant difference in response to brachytherapy was found in the anatomical area treated, size of the tumor, or previously treated vs. naive BCCs. The sclerodermiform histotype had a 7-fold higher risk of recurrence than nodular histotype; recurrence occurred approximately 12 weeks earlier.

CONCLUSION

High-dose 188Re brachytherapy is a noninvasive, easy to perform, well-tolerated approach to treat difficult BCC when surgery or other therapy techniques are not feasible.

Dissolving microneedles for melanoma: Most recent updates, challenges, and future perspectives

Skin cancer is one among the common types of cancers, affecting millions of individual globally. The conventional anticancer therapy such as chemotherapy results in worst systemic and local side effects as well as inhibit the growth of healthy cells around the tumor cells. Dissolving microneedles (DMNs) is a groundbreaking technology with less invasive and more targeted features. Physically, these tiny dissolving needles deliver the anticancer payloads drug to the tumor site after its direct application on the skin surface. Specifically, the DMNs release the anticancer drug cargoes into the cancerous cell sparing the healthy cells around the tumor, thus has provided a significant contribution in the landscape of traditional skin cancer therapy. This targeted therapeutic approach of dissolving microneedles shows a significant therapeutic outcome in decreasing the growth of cancer cells in pre-clinical studies. Dissolving microneedles (DMNs) have demonstrated effectiveness in the targeted delivery of drugs, genes, and vaccines specifically at the site of skin tumors. This method mimics the localized release of adjuvants and immunomodulators, leading to significant humoral and cellular immune responses that are beneficial for skin cancer therapy. In this review, the current trends and potential roles of dissolving microneedles in delivering therapeutic agents focused on treating skin melanoma have been highlighted, drawing insights from recent literature. This emphasizes the promising applications of DMNs in enhancing treatment outcomes for skin cancer patients. Lastly, future perspectives were identified for improving the therapeutic potential and translation of DMNs into clinic.

The diagnostic potential of Asprosin and Meteorin-like proteins in basal and squamous cell carcinomas

Non-melanoma skin cancer (NMSC) is the most prevalent malignancy worldwide, encompassing primarily BCC and SCC. Differentiating between these two carcinomas and distinguishing them from normal skin tissue can pose diagnostic challenges in certain cases. Adipokines, as regulators of various biological processes, have garnered attention for their potential roles in tumorigenesis. Asprosin (Asp) and Meteorin-like (Metrnl) are newly identified proteins implicated in several diseases, including cancer. Their potential contribution to the pathogenesis of skin cancers such as BCC and SCC remains underexplored. This study aimed to evaluate the expression profiles of Asp and Metrnl in BCC and SCC and to assess their potential utility as diagnostic biomarkers. The expression of Asp and Metrnl proteins was examined by immunohistochemical staining in biopsy samples from 60 control, 60 BCC, and 60 SCC cases obtained from the archive of the Pathology Laboratory of Malatya Turgut Ozal University Training and Research Hospital. Asp immunoreactivity was higher in BCC tissues compared to the other two groups, and it was statistically higher in SCC tissues compared to healthy control tissues. Metrnl immunoreactivity was also higher in BCC tissues compared to the other two groups, and statistically significant in SCC tissues when compared to healthy control tissues. The findings suggest that Asp and Metrnl proteins may serve as valuable biomarkers for distinguishing between BCC and SCC, the two most common non-melanoma skin cancers encountered in routine dermatopathology practice. These adipokines may also provide insights into the underlying pathophysiology of these malignancies, offering potential avenues for diagnostic and therapeutic advancements.

Basal Cell Carcinoma in Patients over 80 Years Presenting for Surgical Excision: Clinical Characteristics and Surgical Outcomes

Background. Complete basal cell carcinoma (BCC) excision remains the most common treatment modality. However, its clinical characteristics and the surgical outcomes achieved in patients over 80 years-often with several medical comorbidities and potentially limited life expectancy-have not been thoroughly examined. This clinical study aims to investigate tumor-specific characteristics and surgical outcomes following surgical treatment of BCC in older individuals. Methods. An observational cohort study based on a prospectively maintained database was conducted in a tertiary center using a predetermined protocol. Patients who underwent BCC surgery between January 2010 and September 2024 were included and grouped by age under or over 80 years. The inclusion criterion was a histologically confirmed BCC, while patients with syndromes predisposing BCC development were excluded. Results. Among the 1396 biopsy-proven BCCs, 35% of the patients were older than 80 years. No significant differences were observed in their baseline characteristics. The pathogenic capacity was greater in elderly patients, who exhibited higher rates of multiple and concurrent skin cancers, larger BCC diameters, and routine involvement in high-risk areas. More lesions were classified as high-risk for recurrence, and the surgical treatment was accompanied by a higher frequency of positive or close margins, high-grade subtypes, and perineural invasion. Logistic regression of 1150 BCCs revealed that age > 80, advanced TNM stage, and margin status robustly predict high-risk histology and high NCCN risk of tumor recurrence. Conclusions. This study highlights that BCC in the elderly population tends to present with a more aggressive tumor status, based on the key clinical and pathology features. These findings underscore the need for tailored surgical strategies in this population.

Bee venom: Yesterday's enemy becomes modern medicine for skin cancer

Malignant melanoma is one of the most lethal human malignancies, particularly when it spreads from its initial site in the skin to distant locations with few therapeutic options. While a range of treatment approaches exist, such as chemotherapy, radiation, immunotherapy, and targeted therapy, they typically fail to treat skin cancer, particularly in its late stages. The complex cellular and molecular mechanisms that drive melanoma growth and metastatic dissemination are both varied and complicated, posing significant challenges to the development of effective treatment approaches. As the incidence and burden of this malignancy increase, there is an urgent need for innovative therapeutic techniques. Therefore, it is vital to research alternate therapy options. Several research undertaken in recent years have found that bee venom influences a variety of cancers. The more research into using bee venom to cure skin cancer, the less attention it receives. In this context, the purpose of this proposal is to review a comprehensive assessment of the clinical impact of bee venom against skin cancer, as well as to highlight challenges and excitement down the road.

Exploring the Role of Symptom Diversity in Facial Basal Cell Carcinoma: Key Insights into Preoperative Quality of Life and Disease Progression

Facial basal cell carcinoma (BCC) is the most common skin cancer, yet delays in diagnosis and treatment persist. These delays affect quality of life (QoL), advance disease progression, and increase healthcare burden. This study explores the relationship between symptom diversity, QoL, and care-seeking behaviors, focusing on the impact of symptoms on clinical outcomes and consultation timing. A total of 278 adults with histologically confirmed facial BCC underwent surgical treatment at Vilnius University Hospital from November 2022 to April 2024. The data collected included demographics, tumor characteristics, and self-reported symptoms (pain, bleeding, itching, tumor presence, discomfort, and erosion). Disease-specific QoL was assessed using the Skin Cancer Index. ANCOVA compared QoL across symptom groups, multiple regression analyzed symptom effects on QoL, and logistic regression evaluated care-seeking behavior over time. Cox regression assessed symptom associations with time to medical consultation. The mean time from symptom onset to consultation was 21 months. Tumor presence (27%), erosion (18%), and discomfort (17%) were the most reported symptoms. Discomfort significantly reduced QoL in emotional, social, and appearance domains (p < 0.05). Logistic regression showed tumor presence and pain were associated with earlier care-seeking within 12 months (p < 0.05). Other symptoms, such as bleeding, itching, and erosion, did not significantly influence consultation timing. The findings highlight the need for public education and proactive patient counseling to promote timely intervention and reduce the disease progression.

Efficacy and tolerability of neoadjuvant therapy with Talimogene laherparepvec in cutaneous basal cell carcinoma: a phase II trial (NeoBCC trial)

We present a single-arm, phase II, neoadjuvant trial with the oncolytic virus talimogene laherparepvec (T-VEC) in 18 patients with difficult-to-resect cutaneous basal cell carcinomas. The primary end point, defined as the proportion of patients, who after six cycles of T-VEC (13 weeks), become resectable without the need for plastic reconstructive surgery, was already achieved after stage I (9 of 18 patients; 50.0%); thus the study was discontinued for early success. The objective response rate was 55.6% and the complete pathological response rate was 33.3%. Secondary end points included safety, relapse-free survival and overall survival, time to occurrence of new basal cell carcinomas and biological read outs. Only mild adverse events occurred. The 6-month relapse-free survival and overall survival rates were 100%. In two patients a new basal cell carcinoma was diagnosed. T-VEC led to a significant increase in cytotoxic T cells (P = 0.0092), B cells (P = 0.0004) and myeloid cells (P = 0.0042) and a decrease in regulatory T cells (P = 0.0290) within the tumor microenvironment. Together, neoadjuvant T-VEC represents a viable treatment option for patients with difficult-to-resect basal cell carcinomas (EudraCT no. 2018-002165-19).

Cutting-Edge Technology Without Cutting: Treating Skin Cancer in This Era-A Case Series

BACKGROUND

Traditional treatment methods for non-melanoma skin cancer (NMSC) include surgical excision with histological evaluation, yet advancements such as reflectance confocal microscopy (RCM) and superficial radiation therapy (SRT) offer non-invasive management alternatives. This study aims to evaluate the use of RCM for the evaluation of treatment outcomes after SRT in managing localized NMSC.

METHODS

A prospective interventional case series study was conducted on patients treated for NMSC with SRT between March 2020 and December 2023. Suspected NMSC lesions were initially evaluated with a handheld dermoscope and then imaged at multiple depths using a VivaScope 1500 RCM. Two dermatologists trained in RCM reviewed the images. Confirmed NMSC lesions were biopsied and treated with SRT, followed by RCM imaging at six months post-treatment to assess cancer clearance, scarring, and inflammation.

RESULTS

Of the 38 lesions (composed of SCC (24) and BCC (14)) treated affecting the 29 patients, all lesions showed no residual tumor activity upon conducting follow-up RCM (100% clearance). Scarring and mild erythema were noted clinically. Six lesions demonstrated moderate to severe inflammation at a 6-month follow-up.

CONCLUSIONS

This study demonstrates successful non-invasive management of localized NMSC using RCM and SRT. RCM was able to non-invasively demonstrate complete tumor clearance achieved by SRT with minimal adverse effects. These findings support considering the use of RCM and SRT as primary diagnostic, monitoring, and treatment options for NMSC without the need for biopsies, especially for elderly patients or those unsuitable for surgery due to medical conditions.

Sex-dependent effects in the aged melanoma tumor microenvironment influence invasion and resistance to targeted therapy

There is documented sex disparity in cutaneous melanoma incidence and mortality, increasing disproportionately with age and in the male sex. However, the underlying mechanisms remain unclear. While biological sex differences and inherent immune response variability have been assessed in tumor cells, the role of the tumor-surrounding microenvironment, contextually in aging, has been overlooked. Here, we show that skin fibroblasts undergo age-mediated, sex-dependent changes in their proliferation, senescence, ROS levels, and stress response. We find that aged male fibroblasts selectively drive an invasive, therapy-resistant phenotype in melanoma cells and promote metastasis in aged male mice by increasing AXL expression. Intrinsic aging in male fibroblasts mediated by EZH2 decline increases BMP2 secretion, which in turn drives the slower-cycling, highly invasive, and therapy-resistant melanoma cell phenotype, characteristic of the aged male TME. Inhibition of BMP2 activity blocks the emergence of invasive phenotypes and sensitizes melanoma cells to BRAF/MEK inhibition.

Freedom from Recurrence across Age in Non-Melanoma Skin Cancer Treated with Image-Guided Superficial Radiation Therapy

Non-melanoma skin cancers (NMSCs) are a significant cause of morbidity and mortality; their incidence is increasing most in older patients. NMSCs have traditionally been treated with surgical excision, curettage, Mohs micrographic surgery (MMS), and superficial radiotherapy (SRT). Image-guided SRT (IGSRT) is a treatment option for poor surgical candidates or patients with low- or high-risk, early-stage NMSC who prefer to avoid surgery. This large retrospective cohort study compared 2-, 4-, and 6-year freedom from recurrence in biopsy-proven NMSC lesions treated with IGSRT (n = 20,069 lesions) between patients aged < 65 years (n = 3158 lesions) and ≥65 years (n = 16,911 lesions). Overall freedom from recurrence rates were 99.68% at 2 years, 99.57% at 4 years, and 99.57% at 6 years. Rates did not differ significantly by age (p = 0.8) nor by sex among the two age groups (p > 0.9). There was a significant difference in recurrence among older patients when analyzed by stage (p = 0.032), but no difference by stage in younger patients (p = 0.7). For early-stage NMSCs, IGSRT is a clinically equivalent alternative to MMS and statistically significant in superiority to non-image-guided SRT. This study demonstrates that there is no significant effect of age on 2-, 4-, or 6-year freedom from recurrence in patients with IGSRT-treated NMSC.

Strategies to make human skin models based on cellular senescence for ageing research

Human skin ageing is closely related to the ageing of the whole organism, and it's a continuous multisided process that is influenced not only by genetic and physiological factors but also by the cumulative impact of environmental factors. Currently, there is a scientific community need for developing skin models representing ageing processes to (i) enhance understanding on the mechanisms of ageing, (ii) discover new drugs for the treatment of age-related diseases, and (iii) develop effective dermo-cosmetics. Bioengineers worldwide are trying to reproduce skin ageing in the laboratory aiming to better comprehend and mitigate the senescence process. This review provides details on the main ageing molecular mechanisms and procedures to obtain in vitro aged skin models.

Estimating the Disability-Adjusted Life-Years (DALYs) of Five Most Prevalent Cancers in the Elderly in Markazi Province, Iran, 2019

Background

Cancer is one of the diseases affecting the elderly and can lead to loss of life years. The skin, breast, gastric, colorectal, and lung cancers are five prevalent cancers in the elderly. The present study was conducted to evaluate the incidence and burden of these cancers in the elderly.

Methods

This secondary study was conducted on available extracted data from the population-based cancer registry in Markazi province in 2019. The data of all cases older than 60 years that lived more than six months in Markazi province were extracted. Collecting information involves gathering data on cancer incidence and death rates based on age and sex groups, as well as overall mortality rates. This also includes survival rates, recovery rates for cancer patients, and disability attributed to cancer using the global burden of disease (GBD) standard table from various sources. Various data, including the latest death registration report and the latest cancer registration report for 2019 and the Iran Statistics Center, were obtained. In order to check and analyze the data, Excel and DISMOD2 software were used. In order to analyze the data, formulas for calculating the burden of diseases (DALY=YLL+YLD) were used. For the validity and reliability of the data, the method of preventing the registration of impossible codes and useless codes was used.

Results

The incidence rate of skin, breast, gastric, colorectal, and lung cancers in elderly women was 52.87, 59.02, 67.63, 47.95, and 20.90, respectively, per 100000. DALYs of these cancers in elderly women were 63.15, 423.86, 686.37, 366.49, and 385.18, respectively. The incidence rate of skin, gastric, colorectal, and lung cancers in elderly men was 100.84, 135.80, 49.74, and 68.57, respectively per 100000. DALYs of these cancers in elderly men were 342.31, 1117.01, 337.99, and 452.41, respectively. The highest YLL and YLD were related to gastric cancer (493.31/100,000) and breast cancer (220.84/100,000).

Conclusion

Based on the results of this study, the incidence, mortality, and DALY of skin, breast, stomach, colorectal and lung cancers were higher in the elderly. In this study, the burden of some cancers such as breast, was lower compared to provinces such as Yazd.

Prognostic significance of sentinel lymph node biopsy in elderly with cutaneous melanoma: systematic review and meta-analysis

Sentinel lymph node biopsy is the most powerful prognostic indicator to date for cutaneous melanoma. Even though elderly patients have a lower incidence of sentinel node involvement, its results are still necessary for access to adjuvant therapies. This is highly relevant considering that the Western population shows an aging trend, and the incidence of melanoma has grown exponentially over the years, making elderly patients more likely to die from melanoma than younger ones. We performed a systematic review to investigate the prognostic significance of sentinel lymph node biopsy in elderly patients with melanoma. The systematic review was conducted following the PRISMA guidelines and registered in PROSPERO. The authors searched the Cochrane Database, EMBASE, PubMed, and WOS. Eligible studies for the systematic review were clinical trials, observational population studies, clinical or hospital-based cohort studies, and case-control studies. The meta-analysis was conducted using the R software program applying the meta package. Six reports were identified to meet the inclusion criteria. All studies were retrospective, non-randomized cohorts. The results obtained in this systematic review show a statistically significant influence of sentinel lymph node biopsy on disease-specific survival (HR = 2.87; 95% CI: 1.73-4.74) but also suggest that a positive result negatively impacts disease-free survival (HR = 3.41; 95% CI: 0.96-12.11). This meta-analysis shows that a positive sentinel lymph node biopsy does not imply differences in overall survival but significantly influences disease-specific survival and suggests an unfavorable impact on disease-free survival.

Accelerated Aging and Microsatellite Instability in Recessive Dystrophic Epidermolysis Bullosa-Associated Cutaneous Squamous Cell Carcinoma

Recessive dystrophic epidermolysis bullosa (RDEB) is a severely debilitating disorder caused by pathogenic variants in COL7A1 and is characterized by extreme skin fragility, chronic inflammation, and fibrosis. A majority of patients with RDEB develop squamous cell carcinoma, a highly aggressive skin cancer with limited treatment options currently available. In this study, we utilized an approach leveraging whole-genome sequencing and RNA sequencing across 3 different tissues in a single patient with RDEB to gain insight into possible mechanisms of RDEB-associated squamous cell carcinoma progression and to identify potential therapeutic options. As a result, we identified PLK-1 as a possible candidate for targeted therapy and discovered microsatellite instability and accelerated aging as factors potentially contributing to the aggressive nature and early onset of RDEB squamous cell carcinoma. By integrating multitissue genomic and transcriptomic analyses in a single patient, we demonstrate the promise of bridging the gap between genomic research and clinical applications for developing tailored therapies for patients with rare genetic disorders such as RDEB.

Synergistic Effect of Human Papillomavirus and Environmental Factors on Skin Squamous Cell Carcinoma, Basal Cell Carcinoma, and Melanoma: Insights from a Taiwanese Cohort

Human papillomavirus (HPV) has been implicated in various cancers, including those affecting the skin. The study assessed the long-term risk of skin cancer associated with HPV infection in Taiwan region, using data from the National Health Insurance Research Database between 2007 and 2015. Our analysis revealed a significant increase in skin cancer risk among those with HPV, particularly for squamous cell carcinoma (SCC), the subtype with the highest observed adjusted hazard ratio (aHR) = 5.97, 95% CI: 4.96-7.19). The overall aHR for HPV-related skin cancer was 5.22 (95% CI: 4.70-5.80), indicating a notably higher risk in the HPV-positive group. The risk of skin cancer was further stratified by type, with basal cell carcinoma (aHR = 4.88, 95% CI: 4.14-5.74), and melanoma (aHR = 4.36, 95% CI: 2.76-6.89) also showing significant associations with HPV. The study also highlighted regional variations, with increased risks in southern Taiwan and the Kaohsiung-Pingtung area. Key findings emphasize the importance of sun protection, particularly in regions of high UV exposure and among individuals in high-risk occupations. This research contributes to a better understanding of the complex interactions between HPV and skin cancer risk, reinforcing the importance of preventive strategies in public health.

Incidence Rates and Time Trends of Skin Cancer in Golestan Province, Northeastern Iran, 2005-2018

BACKGROUND

Given the significant occurrence of skin cancer in the Middle East and the existing research gap concerning its incidence and trends, this research aimed to study the epidemiology and trend changes of skin cancer in the Golestan province, Northeastern Iran.

METHODS

The Golestan Population-based Cancer Registry's (GPCR's) data bank was utilized to gather information on confirmed skin cancer cases in the province during 2005-2018. We used Poisson regression analysis for comparing incidence rates between groups. P values less than 0.05 were considered statistically significant.

RESULTS

Of 1690 patients (mean age: 62.05±15.83 years), most were male (60.1%) and resided in urban areas (61.5%). The age-standardized rate (ASR) of non-melanoma and melanoma skin cancer was 8.49 and 0.56 per 100000 persons-year, respectively. A notably higher ASR for non-melanoma skin cancer (NMSC) was observed in men (ASR: 10.60; 95% CI: 9.91-11.29) (P<0.01) and urban residents (ASR: 10.19; 95% CI: 9.52-10.82) (P<0.01). There was no significant difference in the ASR of melanoma skin cancer based on gender (P=0.24) and place of residence (P=0.48). The incidence trend of melanoma (estimated annual percent change [EAPC]: -3.28; 95% CI: -18.54 to 14.83) and NMSC (EAPC: 0.39; 95% CI: -3.99 to 4.97) did not differ significantly.

CONCLUSION

During the 14-year study period, the ASR of both types of skin cancer exhibited a consistent pattern, except for NMSC, which showed higher rates among men and urban residents. This should be taken into consideration when formulating preventive and control strategies in the study area.

The burden of skin diseases in China: global burden of Disease Study 2019

Skin diseases continue to affect human health and cause a significant disease burden on the healthcare system.We aimed to report the changing trends in the burden of skin disease in China from 1990 to 2019, Which has an important role in developing targeted prevention strategies. We applied Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 analytical tools to calculate the age-standardized Prevalence and Incidence in 2019, number of years lived with disability (YLDs) and age-standardized YLDs from 1990 to 2019 of skin and subcutaneous diseases, notifiable infectious skin diseases and skin tumors in China. Among the skin and subcutaneous diseases in China in 2019, dermatitis contributed to the greatest YLD (2.17 million, 95% uncertainty interval[UI]: 1.28-3.36). Age-standardized YLD rates for leprosy decreased from 0.09 (95%UI: 0.06-0.13) in 1990 to 0.04 (95%UI: 0.03-0.06) in 2019; the proportional decrease was 55.56% over 30 years. Age-standardized YLDs for HIV and sexually transmitted infections increased by 26% during the same time period. Age-standardized YLDs for non-melanoma skin cancer increased at a much higher rate than melanoma between 1990 and 2019. Dermatitis and scabies continue to have an important role in the burden of skin and subcutaneous disease burden in China. The burden of non-melanoma cell cancer has increased most significantly over the past three decades.

Early automated detection system for skin cancer diagnosis using artificial intelligent techniques

Recently, skin cancer is one of the spread and dangerous cancers around the world. Early detection of skin cancer can reduce mortality. Traditional methods for skin cancer detection are painful, time-consuming, expensive, and may cause the disease to spread out. Dermoscopy is used for noninvasive diagnosis of skin cancer. Artificial Intelligence (AI) plays a vital role in diseases' diagnosis especially in biomedical engineering field. The automated detection systems based on AI reduce the complications in the traditional methods and can improve skin cancer's diagnosis rate. In this paper, automated early detection system for skin cancer dermoscopic images using artificial intelligent is presented. Adaptive snake (AS) and region growing (RG) algorithms are used for automated segmentation and compared with each other. The results show that AS is accurate and efficient (accuracy = 96%) more than RG algorithm (accuracy = 90%). Artificial Neural networks (ANN) and support vector machine (SVM) algorithms are used for automated classification compared with each other. The proposed system with ANN algorithm shows high accuracy (94%), precision (96%), specificity (95.83%), sensitivity (recall) (92.30%), and F1-score (0.94). The proposed system is easy to use, time consuming, enables patients to make early detection for skin cancer and has high efficiency.

Methotrexate did not add skin cancer risk in patients with psoriasis receiving narrowband ultraviolet B phototherapy: a nationwide retrospective cohort study

BACKGROUND

In the era of biologic therapy, phototherapy and methotrexate (MTX) are still commonly used for treatment in patients with moderate-to-severe psoriasis. However, the skin cancer risk following a combination of MTX and narrowband ultraviolet B (NB-UVB) has rarely been explored.

OBJECTIVES

To investigate whether MTX plus NB-UVB increases skin cancer risk in patients with psoriasis.

METHODS

We conducted a retrospective cohort study of data in the Taiwan National Health Insurance Research Database from 1997 to 2013. Cumulative incidences and multivariate analysis were investigated using a competing risk regression model, comparing skin cancer risk between cohorts of people having combination therapy and those using NB-UVB alone, matched for relative confounders. We further conducted a sensitivity analysis for those receiving a higher MTX dose. Standardized incidence ratios (SIRs) were calculated for skin cancer risk.

RESULTS

We enrolled 3203 participants in each cohort. No significant differences in skin cancers were noted between the two cohorts for the cumulative incidences (log-rank test, P = 0.28) and for the hazard ratio (HRs) [adjusted HR 0.50, 95% confidence interval (CI) 0.15-1.63, P = 0.247] in the competing risk regression model. There were also no significant differences between those receiving higher-dose MTX and UVB alone in the cumulative incidences of skin cancers (P = 0.23) and the HR (adjusted HR = 0.29, 95% CI 0.04-2.21, P = 0.23) in the multivariate analysis. There was no significant difference in the SIR between the two cohorts compared with the general population.

CONCLUSIONS

In the Taiwanese population, MTX does not increase skin cancer risk in patients with moderate-to-severe psoriasis receiving NB-UVB.

Robust high-performance thin-layer chromatography (HPTLC) method for stability assessment and simultaneous quantification of epigallocatechin-3-gallate and rosmarinic acid in lipid-based nanoparticles and biological matrices

INTRODUCTION

Skin cancer poses a significant health risk globally, necessitating effective and safe therapeutic interventions. Epigallocatechin-3-gallate (EGCG) from green tea and rosmarinic acid (RA) from herbs like rosemary offer promising anticancer properties. Combining these compounds may enhance their effectiveness, prompting the need for a reliable analytical method to quantify them.

OBJECTIVE

Herein, we present the development and validation of a high-performance thin-layer chromatography (HPTLC) method for concurrent quantification of EGCG and RA in lipid-based nanoparticles and biological samples.

METHODOLOGY

The method underwent optimisation through design of experiments (DoE), resulting in the establishment of robust chromatographic conditions. The separation process utilised aluminium HPTLC plates coated with silica gel 60 F254 as the stationary phase, with the mobile phase comprising ethyl acetate, toluene, formic acid, and methanol in a ratio of 4:4:1:1 v/v.

RESULTS

The retention factor (Rf) values obtained were 0.38 for EGCG and 0.61 for RA. The method demonstrated linearity over a range of 100-500 ng/band for both compounds with excellent correlation coefficients. Limits of detection and quantification were determined, indicating high sensitivity. Precision evaluations revealed relative standard deviation below 2%, ensuring method reproducibility. Recovery assays in lipid-based nanoparticles, plasma, and urine samples demonstrated excellent recoveries (96.2%-102.1%). Forced degradation studies revealed minimal degradation under various stress conditions, with photolytic degradation showing the least impact.

CONCLUSION

The developed HPTLC method offers a rapid, sensitive, and reliable approach for quantifying EGCG and RA, laying the groundwork for their further investigation as anticancer agents alone and in combination therapies.

Glucagon like peptide-1 receptor agonists and the risk of skin cancer among patients with type 2 diabetes: Population-based cohort study

AIMS

The objective of this study was to determine whether the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with an increased risk of melanoma and nonmelanoma skin cancer, separately, compared with the use of sulfonylureas among patients with type 2 diabetes.

METHODS

Using the United Kingdom Clinical Practice Research Datalink (2007-2019), we assembled two new-user active comparator cohorts. In the first cohort assessing melanoma as the outcome, 11,786 new users of GLP-1 RAs were compared with 208,519 new users of sulfonylureas. In the second cohort assessing nonmelanoma skin cancer as the outcome, 11,774 new users of GLP-1 RAs were compared with 207,788 new users of sulfonylureas. Cox proportional hazards models weighted using propensity score fine stratification were fit to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of melanoma and nonmelanoma skin cancer, respectively.

RESULTS

Compared with sulfonylureas, GLP-1 RAs were not associated with an increased risk of either melanoma (42.6 vs. 43.9 per 100,000 person-years, respectively; HR 0.96, 95% CI 0.53-1.75) or nonmelanoma skin cancer (243.9 vs. 229.9 per 100,000 person-years, respectively; HR 1.03, 95% CI 0.80-1.33). There was no evidence of an association between cumulative duration of use with either melanoma or nonmelanoma skin cancer. Consistent results were observed in secondary and sensitivity analyses.

CONCLUSIONS

In this population-based cohort study, GLP-1 RAs were not associated with an increased risk of melanoma or nonmelanoma skin cancer, compared with sulfonylureas.

Advancements in elucidating the pathogenesis of actinic keratosis: present state and future prospects

Solar keratosis, also known as actinic keratosis (AK), is becoming increasingly prevalent. It is a benign tumor that develops in the epidermis. Individuals with AK typically exhibit irregular, red, scaly bumps or patches as a result of prolonged exposure to UV rays. These growths primarily appear on sun-exposed areas of the skin such as the face, scalp, and hands. Presently, dermatologists are actively studying AK due to its rising incidence rate in the United States. However, the underlying causes of AK remain poorly understood. Previous research has indicated that the onset of AK involves various mechanisms including UV ray-induced inflammation, oxidative stress, complex mutagenesis, resulting immunosuppression, inhibited apoptosis, dysregulated cell cycle, altered cell proliferation, tissue remodeling, and human papillomavirus (HPV) infection. AK can develop in three ways: spontaneous regression, persistence, or progression into invasive cutaneous squamous cell carcinoma (cSCC). Multiple risk factors and diverse signaling pathways collectively contribute to its complex pathogenesis. To mitigate the risk of cancerous changes associated with long-term UV radiation exposure, prompt identification, management, and prevention of AK are crucial. The objective of this review is to elucidate the primary mechanisms underlying AK malignancy and identify potential treatment targets for dermatologists in clinical settings.

Use of a Dermal Regeneration Template in a two-stage reconstruction after extensive skin surgery for Bowen's disease of the anterior neck - Case report

INTRODUCTION

Dermal Regeneration Templates may be used in the reconstruction of large skin defects after cutaneous malignancy excisions. Bowen's disease (BD; squamous cell carcinoma in situ) is a common and persistent condition that can be related to chronic sun damage, and consequently, is usually located on the head and neck area or on the lower limbs. Literature does not provide clear guidelines on the treatment of BD, limiting itself to describing a wide range of different methods that can be used, including surgery, laser therapy or topical options. However, large lesions tend to scar in the post-operative setting and hence are difficult to treat surgically.

PRESENTATION OF CASE

In this paper the authors present a case of a male in his 60s, ASA III score, who presented with a history of histopathologically-confirmed squamocellular carcinoma in the neck and supraclavicular region. Due to recurrent carcinomas the patient was treated with an extensive skin excision and a successful reconstruction using a Dermal Regeneration Template. The work has been reported in line with the SCARE criteria.

DISCUSSION

The main surgical problem caused by BD is reaching complete oncological resection and, consequently, the need for extensive skin excisions.

CONCLUSION

The use of the skin substitute resulted in a satisfactory functional and aesthetic result, with total clearance and no recurrence observed after 16 months.

The Risk of Keratinocyte Cancer in Vitiligo and the Potential Mechanisms Involved

Although light skin types are associated with increased skin cancer risk, a lower incidence of both melanoma and nonmelanoma skin cancer (NMSC) has been reported in patients with vitiligo. We performed a systematic review and meta-analysis on the NMSC risk in patients with vitiligo, indicating a reduced relative risk ratio of NMSC in vitiligo. Furthermore, we propose a series of hypotheses on the underlying mechanisms, including both immune-mediated and nonimmune-mediated pathways. This study reveals insights into the relationship between vitiligo and keratinocyte cancer and can also be used to better inform patients with vitiligo.

Complex Management of Basal Cell Carcinoma in a Frail Patient

Basal cell carcinoma (BCC) is one of the most common cancers diagnosed in older patients and has low mortality. Surgical versus medical management is considered in patients with multiple comorbidities and limited life expectancy (LLE), where the risk-to-benefit ratio must be carefully assessed. Watchful waiting (WW) is a viable option for some patients with severe LLE when follow-up care can be provided vigilantly and frequently. Special consideration should be given to morbidity factors such as tumor growth, bleeding, pain, and social withdrawal that negatively affect the quality of life. We present the case of a 75-year-old male with a past medical history of multiple system atrophy, who presented with a BCC on the ear and face. We discuss the management of this patient and factors that may have led to the inappropriate use of WW.

Epidemiology of Keratinocyte Skin Cancer with a Focus on Cutaneous Squamous Cell Carcinoma

Keratinocyte skin cancer, consisting of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is by far the most common cancer in white-skinned populations, with rapid increases over the last 50 years. While the age-standardized incidence rates increase worldwide, the age-standardized mortality rates are variable. The incidence rates of keratinocyte skin cancer are much higher compared to those of melanoma, and are largely attributed to the raising exposure to ultraviolet (UV) radiation, the most important causal risk factor for skin cancer. Whereas the development of BCC is mainly due to intense UV exposure during childhood and adolescence, the development of SCC is related to chronic, cumulative UV exposure over decades. Although mortality rates are relatively low, SCC is an increasing problem for healthcare services, significantly causing morbidity, especially in older age groups. This review reports on the epidemiology of keratinocyte skin cancer, with a focus on SCC, in Australia, the United States, and the north of Europe, with an outlook on further challenges health systems will be confronted with in the next 20 years.

Keratinocyte Carcinoma Incidence by Race and Ethnicity in Older Adults With Medicare Coverage

This cohort study examines raw and age-adjusted differences in the incidence of keratinocyte carcinoma among Medicare beneficiaries by race and ethnicity.

Health-Related Quality of Life with Pembrolizumab in Patients with Locally Advanced or Recurrent or Metastatic Cutaneous Squamous Cell Carcinoma: KEYNOTE-629

INTRODUCTION

At first interim analysis of KEYNOTE-629, health-related quality of life (HRQoL) with pembrolizumab was stable or improved over 48 weeks in recurrent or metastatic (R/M) cutaneous squamous cell carcinoma (cSCC). HRQoL results from the second interim analysis in R/M or locally advanced (LA) cSCC are presented.

METHODS

Patients received pembrolizumab 200 mg every 3 weeks for ≤ 2 years. Change in EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EQ-5D-5L scores were exploratory end points. Primary analysis was performed at week 12 to ensure adequate completion/compliance. Descriptive analyses were also conducted through weeks 48 and 75 for the LA and R/M cohorts, respectively.

RESULTS

At data cutoff (29 July 2020), mean scores in the LA cohort (n = 47) were stable from baseline to week 12 for EORTC QLQ-C30 global health status (GHS)/quality of life (QoL) (-0.27 points [95% confidence interval (CI) -10.93 to 10.39]), physical functioning (-1.29 points [95% CI  -8.77 to 6.19]), and EQ-5D-5L visual analog scale (2.06 [95% CI -7.70 to 11.82]). HRQoL remained stable through week 48 in the LA cohort; 76.6% and 74.5% of patients had improved or stable GHS/QoL and physical functioning scores, respectively. HRQoL continued to show stability or improvement through week 75 in the R/M cohort (n = 99); 71.7% and 64.6% of patients had improved or stable GHS/QoL and physical functioning scores, respectively.

CONCLUSIONS

Pembrolizumab has demonstrated antitumor activity and manageable safety. The current analysis shows pembrolizumab treatment preserved HRQoL. Collectively, these results support pembrolizumab as standard of care for LA or R/M cSCC.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03284424-September 15, 2017.

Melanoma-specific survival is worse in the elderly: a multicentric cohort study

We aimed to characterise cutaneous melanoma in the elderly and determine its association with poorer prognosis. We studied a prospective cohort of the melanoma population in Catalonia between 2012 and 2016. We compared young patient group (<75 years old) with elderly patient group (≥75 years old). We included 3009 patients (52.5% women) from 14 centres, with a mean age at diagnosis of 61.1 years. In the ≥75-year-old group there was a predominance of men (53.9% vs. 45.5%, P  < 0.001), melanoma was more frequently located in the head and neck area (37.7% vs. 15.5%, P  < 0.001) and lentigo maligna melanoma subtype was significantly more frequent (31.4% vs. 11.6%, P  < 0.001), as were nodular melanoma and acral lentiginous melanoma ( P  < 0.001). In older people, Breslow index, the presence of ulceration and mitotic rate were higher than in younger people. Kaplan-Meier survival curves showed longer melanoma-specific survival (MSS) and melanoma-free survival (MFS) in <75-year-old group compared to the elderly group. Cox regression models demonstrated reduced MSS in patients ≥75 years regardless of gender, location, IB, ulceration and lymph node status at diagnosis (HR 1.54, P  = 0.013) whereas MFS was not independently associated with elderly when head and neck location was considered. Age appears to be an independent risk factor for MSS but not for MFS. Worse melanoma prognosis in elderly could be explained by factors unrelated to the tumour, such as age-related frailty and comorbidities that limit the access to systemic treatments and, eventually, age-related immune dysfunction.

Comparative Analysis of Alpha and Beta HPV E6 Oncoproteins: Insights into Functional Distinctions and Divergent Mechanisms of Pathogenesis

Human papillomaviruses (HPVs) represent a diverse group of DNA viruses that infect epithelial cells of mucosal and cutaneous tissues, leading to a wide spectrum of clinical outcomes. Among various HPVs, alpha (α) and beta (β) types have garnered significant attention due to their associations with human health. α-HPVs are primarily linked to infections of the mucosa, with high-risk subtypes, such as HPV16 and HPV18, being the major etiological agents of cervical and oropharyngeal cancers. In contrast, β-HPVs are predominantly associated with cutaneous infections and are commonly found on healthy skin. However, certain β-types, notably HPV5 and HPV8, have been implicated in the development of non-melanoma skin cancers in immunocompromised individuals, highlighting their potential role in pathogenicity. In this review, we comprehensively analyze the similarities and differences between α- and β-HPV E6 oncoproteins, one of the major drivers of viral replication and cellular transformation, and how these impact viral fitness and the capacity to induce malignancy. In particular, we compare the mechanisms these oncoproteins use to modulate common cellular processes-apoptosis, DNA damage repair, cell differentiation, and the immune response-further shedding light on their shared and distinct features, which enable them to replicate at divergent locations of the human body and cause different types of cancer.

Skin Cancer Diagnosis Among People With Disabilities

INTRODUCTION

People with disabilities face unique challenges that may affect skin cancer prevention, diagnosis, and access to treatment. These challenges could be exacerbated by the COVID-19 pandemic. In 2022, the prevalence of self-reported skin cancer diagnoses, delayed medical care because of the coronavirus disease 2019 (COVID-19) pandemic, and skin cancer risk factors among people with disabilities were estimated.

METHODS

Data from the 2020 National Health Interview Survey (N=31,568 U.S. adults) were analyzed. Skin cancer diagnosis, age at the time of skin cancer diagnosis, skin cancer risk factors (e.g., sun protection), and delayed medical care because of the COVID-19 pandemic were included. Disability status was measured using the Washington Group Short Set on Functioning, which includes vision, hearing, mobility, communication, self-care, and cognitive disabilities.

RESULTS

Although 8.8% of U.S. adults reported having a disability, people with disabilities accounted for 14.7% of all self-reported skin cancer diagnoses, including 17.5% of melanoma diagnoses. Notably, people with disabilities were on average, older (mean age=59.8 years) than people without disabilities (mean age=46.8 years). Models that adjusted for age and other demographics revealed that people with disabilities had higher odds of delaying medical care because of the COVID-19 pandemic (OR=1.65, 95% CI=1.41, 1.94); people with disabilities reported being diagnosed with skin cancer later in life (age 61.5 vs 54.0 years; p<0.001) but had odds of reporting any skin cancer (OR=1.11, 95% CI=0.93, 1.32) or melanoma diagnosis (OR=1.33, 95% CI=0.95, 1.87) similar to those of people without disabilities.

CONCLUSIONS

Because of disability-related challenges, older age, and delaying medical care during the pandemic, people with disabilities may be at increased risk for inequitable skin cancer outcomes.

Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group

Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis.

Combined Nivolumab and Ipilimumab in Octogenarian and Nonagenarian Melanoma Patients

Data regarding elderly melanoma patients treated with anti-PD-1 or anti-CTLA-4 antibodies are in favor of tolerability outcomes that are similar to those of younger counterparts. However, there are very few studies focusing on elderly patients receiving nivolumab combined with ipilimumab (NIVO + IPI). Here, we ask what are the current prescribing patterns of NIVO + IPI in the very elderly population and analyze the tolerance profile. This French multicenter retrospective study was conducted on 60 melanoma patients aged 80 years and older treated with NIVO + IPI between January 2011 and June 2022. The mean age at first NIVO + IPI administration was 83.7 years (range: 79.3-93.3 years). Fifty-five patients (92%) were in good general condition and lived at home. Two dosing regimens were used: NIVO 1 mg/kg + IPI 3 mg/kg Q3W (NIVO1 + IPI3) in 27 patients (45%) and NIVO 3 mg/kg + IPI 1 mg/kg Q3W (NIVO3 + IPI1) in 33 patients (55%). NIVO + IPI was a first-line treatment in 39 patients (65%). The global prevalence of immune-related adverse events was 63% (38/60), with 27% (16/60) being of grade 3 or higher. Grade ≥ 3 adverse events were less frequent in patients treated with NIVO3 + IPI1 compared with those treated with NIVO1 + IPI3 (12% versus 44%, p = 0.04). In conclusion, the prescribing patterns of NIVO + IPI in very elderly patients are heterogeneous in terms of the dosing regimen and line of treatment. The safety profile of NIVO + IPI is reassuring; whether or not the low-dose regimen NIVO3 + IPI1 should be preferred over NIVO1 + IPI3 in patients aged 80 years or older remains an open question.

Advanced non-melanoma skin cancer in elderly patients: When surgery says NO, interventional radiotherapy (brachytherapy) says YES

Purpose

The prevalence of non-melanoma skin cancer (NMSC) increases, especially in older adults with comorbidities, narrowing radical treatment options. About 5% of skin cancer patients are diagnosed with an advanced stage, which impairs daily functioning. The study was to present a retrospective summary of elderly patients unfit for surgery and treated with various brachytherapy (BT) techniques tailored individually for locally advanced NMSCs in a reference BT department. Clinical case presentations supported the findings.

Material and methods

Inoperable patients older than 75 years presenting with advanced pathologically confirmed NMSCs were retrospectively identified. All cases were individually assessed, and the best suiting radical treatment option was chosen, including contact, interstitial, or hybrid high-dose-rate (HDR) or pulsed-dose-rate (PDR) BT. Doses ranging from 45 to 60 Gy were administered to clinical target volume (CTV) in different time schedules. All patients were closely followed-up until complete remission.

Results

Ten elderly patients (mean age, 84 years) with differently located locally advanced NMSCs (all staged T3) were treated between 2007 and 2022. Six basal and four squamous cell carcinoma cases showed most painful symptoms as well as bleeding and exudation. Six patients underwent HDR-BT and four PDR-BT. Six patients had superficial, and four interstitial or hybrid applications. All patients completed the intended protocols. Median follow-up was 8.5 months (range, 3-35 months). Six out of ten patients died from other reasons before analysis. All case data were presented in the text and respective figures.

Conclusions

Advanced NMSCs in elderly patients are challenging in terms of cure. Inoperable cases may be referred for feasible and locally effective interventional radiotherapy (BT). Individually tailored BT leads to an excellent disease control, function sparing, symptoms release, and quality of life improvement. Large treated volumes are related to prolonged healing. BT should be discussed in a multidisciplinary tumor board regarding older patients with symptomatic functions affecting advanced NMSCs.

Real-world analysis of cost, treatment patterns, and outcomes of patients with metastatic cutaneous squamous cell carcinoma in the US

OBJECTIVES

To describe real-world characteristics and treatment patterns of patients with metastatic cutaneous squamous cell carcinoma (mCSCC).

METHODS

This retrospective observational study used MarketScan Commercial and Medicare Supplemental claims databases (1/1/2013-7/31/2019). Adult patients with mCSCC who initiated non-immunotherapy systemic treatment (i.e. index event) between 1 January 2014 and 31 December 2018 were assessed for treatment patterns, all-cause and CSCC-related healthcare resource utilization, costs, and mortality .

RESULTS

Overall, 207 patients were included in the study(mean age 64.8 years, 76.3% male), 59.4% had prior radiotherapy, and 58.9% had prior CSCC-related surgery. During follow-up, 75.8%, 51.7%, and 35.7% of patients received chemotherapy, radiotherapy, and targeted therapy as first-line treatment, respectively. Cisplatin (32.9%) and carboplatin (22.7%) were the most common chemotherapy agents, and cetuximab (32.4%) was the most common targeted therapy during the first-line.Probability of death (95% CI) at month 6, year 1, and year 2 was 24% (16-32%), 50% (40 - 59%), and 67% (56 - 75%), respectively. Average CSCC-related healthcare costs were $5,354 per person per month (PPPM), with outpatient costs being the major cost driver at 96.4% ($5,160 PPPM).

CONCLUSION

During 2014-2018, patients with mCSCC were commonly treated with cisplatin and cetuximab; prognosis was generally poor. These results indicate opportunity for new treatments to improve survival outcomes.

Ultrasonographic Assessment of Depth Infiltration in Melanoma and Non-melanoma Skin Cancer

The preoperative assessment of infiltration depth in melanoma and non-melanoma skin cancer by means of high-frequency ultrasound (≥18 MhZ) is essential for optimizing the therapeutic approach in our patients. Often, histologically confirmed skin tumors are directly referred to surgical departments for resection, and sonography is increasingly helping us identify those subjects who are no longer candidates for extensive surgical interventions. In cases of deep tumor infiltration, with potential surgical failure e.g. impairment of the quality of life and significant esthetic and functional complications, preoperative sonography can guide the surgeon to withstand from an operation and decide instead in favor of less mutilating radiooncological or medical treatment options. Furthermore, in melanoma patients, the preoperative knowledge of the tumor depth is essential for the determination of the therapeutic approach, the correct safety margins and the need of a sentinelnode biopsy. We herein encourage the use of preoperative sonography in dermatologic surgery whenever possible as it represents an easy, painless, "in vivo" method, which provides clinicians with significant clinical information that can influence the therapy and improve patient compliance.

Radiologically Defined Sarcopenia as a Biomarker for Frailty and Malnutrition in Head and Neck Skin Cancer Patients

The aim of this study was to evaluate whether radiologically defined sarcopenia, or a low skeletal muscle index (SMI), could be used as a practical biomarker for frailty and postoperative complications (POC) in patients with head and neck skin cancer (HNSC). This was a retrospective study on prospectively collected data. The L3 SMI (cm²/m²) was calculated with use of baseline CT or MRI neck scans and low SMIs were defined using sex-specific cut-off values. A geriatric assessment with a broad range of validated tools was performed at baseline. POC was graded with the Clavien-Dindo Classification (with a grade of > II as the cut-off). Univariate and multivariable regression analyses were performed with low SMIs and POC as the endpoints. The patients' (n = 57) mean age was 77.0 ± 9 years, 68.4% were male, and 50.9% had stage III-IV cancer. Frailty was determined according to Geriatric 8 (G8) score (OR 7.68, 95% CI 1.19-49.66, p = 0.032) and the risk of malnutrition was determined according to the Malnutrition Universal Screening Tool (OR 9.55, 95% CI 1.19-76.94, p = 0.034), and these were independently related to low SMIs. Frailty based on G8 score (OR 5.42, 95% CI 1.25-23.49, p = 0.024) was the only variable related to POC. However, POC was more prevalent in patients with low SMIs (∆ 19%, OR 1.8, 95% CI 0.5-6.0, p = 0.356).To conclude, a low SMI is a practical biomarker for frailty and malnutrition in HNSC. Future research should be focused on interventions based on low SMI scores and assess the effect of the intervention on SMI, frailty, malnutrition, and POC.

Measuring the quality of skin cancer management in primary care: A scoping review

Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.

Recommendations of the International Society of Geriatric Oncology on skin cancer management in older patients

INTRODUCTION

Non-melanoma skin cancer (NMSC) is becoming ever more prevalent among older adults. However, older adults with NMSC are often underrepresented in clinical trials and guidelines on effective management is still unclear. The International Society of Geriatric Oncology (SIOG) created a multi-disciplinary task force to explore the potential in developing practical guidelines for the treatment of older patients with basal cell carcinoma (BCC) and skin (cutaneous) squamous cell carcinoma (cSCC).

MATERIALS AND METHODS

A systematic literature search to identify relevant and up-to-date literature on treatment of NMSC in older adults was conducted on various databases including MEDLINE, Embase, CINAHL, Cochrane, and PubMed. The resulting papers were discussed by an expert panel, leading to a consensus recommendation.

RESULTS

A total of 154 articles were identified for the expert panel to utilise in generating consensus recommendations. A major focus on geriatric assessment and management options including surgery, radiotherapy, systemic therapy, clinical monitoring, and medical/medicophysical therapy were reviewed for recommendations.

DISCUSSION

Patient age should not be the sole deciding factor in the management of patients with NMSC. Assessment from a multidisciplinary team (MDT) is crucial, and the decision-making process should consider the patient's lifestyle, needs, and expectations. A comprehensive geriatric assessment should also be considered. Patients should feel empowered to advocate for themselves and have their views considered a part of the MDT discussion.

Proposed guidelines for appropriate utilization of superficial radiation therapy in management of skin cancers. Zemtsov-Cognetta criteria

OBJECTIVE

To develop appropriate use criteria (AUC) for the treatment of basal cell and squamous cell carcinoma by superficial radiation therapy (SRT) technique.

MATERIAL AND METHODS

Delphi-type discussion of the experts.

RESULTS

Presented in Figure 1.

CONCLUSION

These AUCs are in compliance both with the position statement of the American Academy of Dermatology (AAD) and the ASTRO Clinical Practice Guideline on this subject. It is further recommended that SRT will be only performed by either a dermatologist who is board certified in Mohs surgery (MDS) and who had adequate SRT training or by radiation oncologists. Hopefully, this publication will stimulate further discussion on this topic.

Incidence and Risk Factors for Incidental Cancer on Melanoma Wide Excisions

INTRODUCTION

Cancer patients and survivors have a high risk of developing additional malignancies. Patients who undergo melanoma excision often have sun-damaged skin and are predisposed to concurrent and subsequent skin cancers. The unexpected finding of an incidental cancer on melanoma wide excisions can require further surgery and delays adjuvant treatment. We aimed to determine the incidence and risk factors for incidental skin cancers in patients who had surgical excision of melanoma.

METHODS

Our single-center retrospective study analyzed all patients diagnosed with primary melanoma at our institution from July 1, 2019 through June 30, 2020. We included patients with localized cutaneous melanoma who underwent surgical excision and had relevant pathology data available. Descriptive statistics and univariate analyses were performed on the demographic, clinical, and pathological data collected. We analyzed differences between the groups with and without incidental cancer to ascertain risk factors using chi-squared tests and Wilcoxon rank sum tests. Dunn's tests with Bonferroni correction were performed for multiple pairwise comparisons.

RESULTS

There were 642 patients who met the criteria for inclusion, of whom 13 (2.0%) had incidental cancers identified on a pathologic assessment. Six (46%) had incidental squamous cell carcinoma and seven (54%) had basal cell carcinoma. With regard to management of incidental cancer, three (23%) patients required additional surgery for margin re-excision. Risk factors for incidental cancers in melanoma excision included older age (median 79 versus 62 y, P < 0.001), male sex (P = 0.042), and primary tumor location in the head/neck region relative to trunk (P < 0.01) or extremity (P < 0.01) primary sites.

CONCLUSIONS

Although the frequency of incidental findings on melanoma excision is low, certain patients are at a greater risk including older male individuals with head/neck melanomas. These findings can be used to improve preoperative counseling of at-risk patients when melanoma excision is planned.

The effect of COVID‐19 on surgical management of skin cancers of the head, face and neck in elderly patients

Background

The Corona Virus (COVID-19) has had a profound impact on healthcare systems worldwide, with interruptions to medical practices including the delivery of cancer treatment. Skin cancer is one of the leading causes of malignancy worldwide, with later stages of disease correlating to poorer prognosis. Immunocompromized and elderly patients represent populations that are at higher risk for adverse outcomes related to skin cancer, treatment delay and COVID-19 infection.

Methodology

Patients aged 65 and above who underwent surgical management of skin cancers from 31 January 2020 to 31 January 2021 were included in this study then compared with samples pre- and post-pandemic. Retrospective analysis was performed regarding: date of referral to date of surgery, skin cancer type, location of cancer, surgery performed, anaesthesia used, sutures used and outcomes. Data was compared to national guidelines.

Results

Five hundred and twenty skin cancers were included in this analysis, of which 340 were treated during the COVID-19 pandemic. Of the cohort treated during the pandemic, 44.2% (n = 111) received excision and direct closure, 13.1% (n = 33) underwent reconstruction by integra dermal substitute, 3.2% (n = 8) by split thickness skin graft, 6.4% (n = 16) by full thickness skin grafts and 33.1% (n = 83) by local flaps. Complete excision was achieved in 88.5% of cases (n = 301). The mean time from referral to surgery was 119 days. There were no deaths associated with COVID-19.

Conclusion

Safe and prompt treatment of head and neck skin cancers is achievable despite the COVID-19 pandemic. Measures to minimize infection risk include the use of teledermatology, reliable COVID-19 testing, Green Pathways and a reduction in the mean referral to surgery time.

An epidemiological study on skin tumors of the elderly in a community in Shanghai, China

The morbidity of skin tumors (ST) in China is a great concern as the population ages. No epidemiological survey on ST in elderly communities in China has been reported. A questionnaire survey was conducted among the residents over 60 years old in a community in Shanghai, China from May 1, 2011 to November 30, 2011. The prevalence of cutaneous tumors and associated factors were analyzed. Among 2038 valid cases, a total of 78 (3.8%, 95% CI 3.0-4.7) skin cancers (SC) were confirmed. According to the final multivariate regression analysis, age, gender and previous occupation were the significantly influential factors for SC. Actinic keratosis (AK) accounted for the largest proportion (63, 3.1%) in SC. The head and neck was the physiological site with the highest incidence of SC (64, 82.1%), and AK was the most common (55, 87.3%) in head and neck SC. The common concomitant diseases of SC were hypertension (26, 33.3%) and diabetes mellitus (9, 11.5%). Seborrheic keratosis (SK) was the most common benign skin tumor with a prevalence of 100%. Men and women developed SK in significantly different parts of the body (P < 0.0001). The incidence of ST in the elderly population in Shanghai community increased with age. ST preferred to occur in the head and neck, which might be attributed to excessive ultraviolet (UV) exposure in these areas. Therefore, early diagnosis and sun-protection education are essential interventions for ST in the elderly.

Association of the Depth of Invasion With Recurrence Rates of Basal Cell Carcinoma in a Tertiary Health Care Facility: A Retrospective Study Over a Period of Six Years

Background Basal cell carcinoma (BCC) is one of the most common types of cutaneous malignancies and the most frequently occurring form of cancer worldwide. The incidence of basal cell carcinoma is difficult to determine due to its wide geographic variations; however, it has been increasing worldwide with an annual increase of 7% in the number of reported cases. Although BCC is more prevalent in the aging population, diagnosis in younger individuals is steadily increasing. BCC has overall low mortality, however, it leads to significant economic and physical impact on patients and their families along with adding burden to the healthcare system. The primary risk factor for the development of BCC is increased cumulative sun exposure, particularly to UV radiation. The UV index of Karachi averages around 12 (extremely high) during summer months, putting the population at a significantly higher risk of developing BCC in the long term. Objectives This audit was undertaken with the following primary objectives: to use the data collected to determine possible prognostic factors for BCC, to measure the rate of recurrence and the number of new primary tumors detected, to study the completeness of follow-up by patients, and to co-relate histopathological findings with the recurrence rate of basal cell carcinoma. Methods A retrospective analysis was performed for all patients with BCC who had undergone surgical resection over a six-year time period. Patient charts were reviewed for demographic information, tumor size, onset-to-diagnosis, anatomic location, clinical subtype, histologic differentiation, method of surgical treatment, and recurrence. Data were entered and analyzed in SPSS version 23 (IBM Corp., Armonk, NY). Results The review identified cases of BCC in 99 patients. Of the 99 patients, 60.39% were men and 38.38% were women. The most frequent age group was 65-85-year-olds (42 patients, 42.85%) for BCC. Based on the aesthetic units of the face, the most common location was the nasal unit (30 cases, 30.30%) for BCC. Most of the lesions were closed primarily; however; local flaps were used in the case of surgical defects. The recurrence rate was 19.19% for BCC in this study. Our study included 1.0% of patients who were classified as Clark classification level 2 of BCC, 6.1% as Clark level 3, 23.4% as Clark level 4, and 0.16% as Clark level 5. Recurrence rates were seen to increase with increasing Clark classification level in this study. Conclusion In our study, many characteristics of BCC were compared to previously published reports and the results were seen to be generally similar. This study correlates the recurrence of BCC with Clark's classification, showing that depth of invasion is a significant factor in predicting recurrence. There is a paucity of literature regarding the depth of invasion of BCC along with its' Clarks classification and recurrence. Further studies can help explore and establish the characteristics of BCC.