Epidemiological trends in skin cancer

Risk factors for incomplete excision of cutaneous squamous cell carcinoma: A single-center study performed on 1082 excisions in Northern Italy

Cutaneous squamous cell carcinoma, which makes up for 25% of keratinocyte carcinomas, is the second most frequent skin cancer worldwide. Surgical excision via a clinical and microscopic complete resection is the treatment of choice. Incomplete excisions carry the risk of local recurrence, deep subclinical progression, and metastasis. This retrospective cohort study aimed to investigate the risk factors associated with the incomplete excision of cutaneous squamous cell carcinoma. This series included 837 patients who underwent surgical treatment for 1082 primary cutaneous squamous cell carcinoma in the Plastic Surgery Department of the Papa Giovanni XXIII Hospital in Bergamo, Northern Italy between 2012 and 2021. Patient-, procedure-, and tumor characteristics were collected and analyzed. Incomplete excision rate was 11.8% (n=128). The Pearson chi-squared test and univariable logistic regression showed tumor diameter [cm] (p<0.001), tumor thickness [mm] (p<0.001), tumor location (ear p=0.006, peri-orbital, p=0.029), differentiation grade (G3=0.005), infiltration level (hypodermis, p<0.001; muscle, p=0.013; bone/ cartilage p<0.001), presence of perineural invasion (p=0.041), ulceration (p=0.010), no prior diagnostic biopsy (p=0.041), and additional samples taken (p<0.001) with additional samples not free of tumor cells (p<0.001) to be significant risk factors/ predictors for incomplete excision. Risk factors should be considered in the management of cutaneous squamous cell carcinoma. This study documented several key contributions and confirmations regarding the risk factors associated with incomplete excision in cutaneous squamous cell carcinoma by comprehensively analyzing of one of the largest cohort studies in the field.

Electrochemotherapy in the Management of Keratinocyte Carcinomas: A Systematic Review

BACKGROUND

Keratinocyte carcinomas, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), presents a growing concern. Electrochemotherapy (ECT), an emerging treatment modality, combines chemotherapy and electroporation to enhance drug delivery into cells. However, reviews evaluating ECT in keratinocyte carcinomas are lacking.

OBJECTIVES

This study reviews the efficacy and toxicity of ECT in the treatment and palliation of keratinocyte carcinomas.

METHODS

A systematic search was conducted across PubMed, Cochrane, Embase, and Scopus databases. Patient, tumor, and treatment characteristics, tumor response, long-term disease outcomes, and toxicity data were extracted. Quality of studies was assessed using validated tools. Primary endpoints included tumor response; secondary endpoints included long-term disease outcomes and toxicity.

RESULTS

Twenty-one studies were included. Complete response (CR) rates ranged from 50 to 100% and from 10 to 100% for BCC and SCC, respectively. OS rates ranged from 95 (14 months) to 100 (1 year) % and from 64 (1 year) to 85.1 (8.6 months) % for BCC and SCC, respectively. One-year local disease-free survival (LDFS) rates were 89% and 87% for BCC and SCC, respectively. For BCC, local progression-free survival (LPFS) rates were 96% (1 year), 90% (2 year), and 70% (5 year). For SCC, 1-year LPFS rates were 80% on a per-patient basis and 49% on a per-lesion basis.

CONCLUSIONS

ECT is effective and tolerable in the treatment and palliation of keratinocyte carcinomas. Future studies should focus on improving reporting quality, optimizing treatment protocols, and investigating long-term outcomes.

Illuminating Hope for Tumors: The Progress of Light-Activated Nanomaterials in Skin Cancer

Skin cancer is a common malignant tumor that poses significant global health and economic burdens. The main clinical types include malignant melanoma and non-melanoma. Complications such as post-surgical recurrence, wound formation, or disfigurement can severely impact the patient's mental well-being. Traditional treatments such as surgery, chemotherapy, radiation therapy, and immunotherapy often face limitations. These challenges not only reduce the effectiveness of treatments but also negatively impact patients' quality of life. Phototherapy, a widely used and long-standing method in dermatology, presents a promising alternative for skin cancer treatment. Light-triggered nanomaterials further enhance the potential of phototherapy by offering advantages such as improved therapeutic precision, controlled drug release, minimal invasiveness, and reduced damage to surrounding healthy tissues. This review summarizes the application of light-triggered nanomaterials in skin cancer treatment, focusing on the principles, advantages, and design strategies of photodynamic therapy (PDT), photothermal therapy (PTT), and photoacoustic therapy (PAT). In this manuscript we have an in-depth discussion on overcoming translational barriers, including strategies to enhance light penetration, mitigate toxicity, reduce production costs, and optimize delivery systems. Additionally, we discuss the challenges associated with their clinical translation, including limited light penetration in deep tissues, potential toxicity, high production costs, and the need for advanced delivery systems.

Predictive Factors for Sentinel Lymph Node Positivity in Melanoma Patients-The Role of Liquid Biopsy, MicroRNA and Gene Expression Profile Panels

The identification of predictive factors for sentinel lymph node (SLN) positivity in melanoma patients is crucial for accurate staging, prognosis, and personalized therapeutic decisions. This review synthesizes recent advancements in molecular and clinicopathological predictors, with a particular focus on liquid biopsy and gene expression profiling (GEP) tools. Emerging evidence highlights the significant role of miRNAs in melanoma progression, metastatic potential, and lymphatic spread. Clinicopathological factors such as Breslow thickness, ulceration, and mitotic rate remain critical, while GEP provides additional precision by uncovering tumor-specific molecular pathways. By integrating these tools, clinicians can improve risk stratification, reduce unnecessary procedures, and personalize management strategies.

Overview of skin cancer types and prevalence rates across continents

Skin cancer is one of the most prevalent cancers in the world, and its incidence and mortality rates are increasing continuously, mostly in regions with white-skinned inhabitants. The types of skin cancer vary in their origin and clinical appearances and also differ in their extensiveness. The continents of the world have different scenarios of skin cancer prevalence. This review aims to explore the different types of skin cancer, their clinical features, and their worldwide prevalence based on the literature. Literature from different electronic databases, including Google Scholar, ResearchGate, PubMed, Scopus, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Elsevier, and Springer, were collected through a literature search using specific keywords such as "skin cancer", "skin cancer types", "melanoma", "non-melanoma", "skin cancer continental prevalence" or similar keywords. The search included English publications from 2000 to 2024. Melanoma skin cancer (MSC) ranks 17th in global prevalence, with the highest incidence and deaths occurring in Europe, However, Australia and New Zealand record the highest incidence and mortality rates. Asia has a lower incidence rate of melanoma, but a higher mortality rate. Superficial spreading melanoma (SSM) is the most common type of MSC. Non-melanoma skin cancers (NMSCs) have the highest incidence in North America, with the highest number of deaths occurring in Asia, Australia and New Zealand have the highest incidence rates for basal cell carcinoma (BCC). BCC is the most commonly diagnosed skin cancer worldwide and the most prevalent form of NMSCs; however, squamous cell carcinoma is the most aggressive form of NMSCs, causing more deaths. NMSCs are the most prevalent cancers worldwide, causing most skin cancer-related deaths. The prevalence of skin cancer rising globally, with several continents experiencing higher incidence and mortality rates. The types and subtypes of skin cancer are becoming more common among clinically diagnosed cancers. This review comprehensively describes skin cancer types and their prevalence worldwide. However, the actual prevalence of skin cancer in these countries should be investigated. Further research on the prevalence of skin cancer across different continents is required to develop more effective cancer management strategies and control the spread of the disease.

Longitudinal analysis of hospital morbidity and mortality due to skin cancer from 2012 to 2022: comparison with demographic and geographic factors in Brazilian states

BACKGROUND

Skin cancer is the most common neoplasm among Brazilians, accounting for 31.3% of all cancer cases in the country.

OBJECTIVES

To analyze the longitudinal morbimortality of skin cancer and compare it with the latitude and the prevalence of white skin color in each federative unit of the country.

METHODS

An ecological observational study was carried out using data from the Hospital Information System (SIH) and the Mortality Information System (SIM).

RESULTS

In Brazil, morbidity rates (per 100,000 inhabitants) increased from 14.88 to 27.69 (p < 0.05) when comparing the years 2012 and 2022, whereas the mortality rates (per 100,000 inhabitants) increased from 0.35 to 0.54 (p < 0.05) during the same period. Furthermore, most states showed an increase in morbimortality rates. Concerning race/ethnicity, individuals with white skin had the highest morbimortality rates. Regarding the age groups, individuals over 50 years old had the highest morbidity rates, while patients over 80 years old had the highest mortality rates, at 23.29%. Finally, the latitude showed a negative correlation, meaning that lower latitudes presented higher rates of morbidity and mortality from skin cancer.

STUDY LIMITATIONS

Self-reporting of skin color by participants, which may not fully correspond to phototypes. Data was analyzed exclusively from hospitalizations through the Unified Health System (SUS) and severe cases of the disease, as this study focused on hospitalizations and mortality, considering that the main treatment for skin cancer is carried out on an outpatient basis.

CONCLUSIONS

The majority of Brazilian states showed rising morbimortality rates during the period, with the white-skinned population being the most affected. Additionally, a negative correlation with latitude was observed.

5-Fluorouracil- and Sesamol-Loaded Transliposomal Gel for Skin Cancer: In Vitro, Ex Vivo, and Dermatokinetic Evaluation

This study explores a novel approach to managing skin conditions through a combination therapy utilizing a phospholipid-enriched edge activator-based nanoformulation. 5-Fluorouracil (5-FU)- and sesamol (SES)-loaded transliposomes (FS-TL) were developed using a thin film hydration method and optimized using Box-Behnken Design. FS-TL characterization indicated a vesicle size of 165.6 ± 1.1 nm, polydispersity index of 0.28 ± 0.01, and a zeta potential of -33.17 ± 0.9 mV, and the percent entrapment efficiencies for 5-FU and SES were found to be 63.16 ± 1.07% and 75.60 ± 3.68%, respectively. The drug loading percents for 5-FU and SES were found to be 5.87 ± 0.099% and 7.03 ± 0.34%, respectively. The morphological studies exhibit the distinctive spherical shape of the nanoformulation. The in vitro drug release demonstrated sustained release with 82.52 ± 1.2% and 86.28 ± 1.3% releases for 5-FU and SES, respectively. The ex vivo skin permeation exhibited 81.04 ± 2.1% and 78.03 ± 1.7% for 5-FU and SES. Confocal laser microscopy scanning (CLSM) revealed a deeper formulation penetration (30.0 μm) of excised mice skin membranes than for a standard rhodamine solution (10.0 μm). The dermatokinetic investigation revealed that FS-TL gel has significantly higher concentrations of 5-FU and SES (p < 0.001). The efficacy of FS-TL (p < 0.05) in eradicating the A431 melanoma cell line was satisfactory. These findings suggest the potential of FS-TL formulation over conventional approaches in skin cancer management.

Trend of skin cancer mortality and years of life lost in China from 2013 to 2021

Background

The mortality rates of skin cancer in Chinese population are increasing. However, research on skin cancer trends in China is limited. This study aimed to estimate the mortality trends of skin cancer in China within 2013-2021.

Methods

A retrospective analysis of skin cancer deaths within 2013-2021 was performed using the China death cause surveillance dataset compiled by the National Health Commission Statistics Information Center and the China Center for Disease Control and Prevention Chronic Non-Communicable Diseases Prevention and Control Center. The mortality rates of skin cancer were stratified by gender, age group, and area (urban or rural).

Results

From 2013 to 2021 in China, the crude mortality rate (CMR) of skin cancer increased, and the age-standardized mortality rate (ASMR), and age-standardized years of life lost (YLL) rate decreased. The ASMR and age-standardized YLL rate were 0.85/100,000 and 18.95/100,000 in 2013, respectively, and decreased to 0.75/100,000 and 16.84/100,000, respectively, in 2021. From 2013 to 2021, the CMR, ASMR, and age-standardized YLL rate of skin cancer were higher in males than in females and higher in rural areas rather than in urban ones. In terms of the highest age-specific mortality rate, it appeared in the age group of over 85 years old.

Conclusion

The burden of skin cancer remained heavily from 2013 to 2021 in China. Especially males, older adult, and rural residents had higher mortality. Thus, effective measures and strategies should be taken to reduce the incidence and mortality of skin cancer.

Elevating Therapeutic Penetration: Innovations in Drug Delivery for Enhanced Permeation and Skin Cancer Management

Skin cancer stands as a challenging global health concern, necessitating innovative approaches to cure deficiencies within traditional therapeutic modalities. While conventional drug delivery methods through injection or oral administration have long prevailed, the emergence of topical drug administration presents a compelling alternative. The skin, aside from offering a swift and painless procedure, serves as a reservoir, maintaining drug efficacy over extended durations. This comprehensive review seeks to shed light on the potential of nanotechnology as a promising avenue for efficacious cancer treatment, with a particular emphasis on skin cancer. Additionally, it underscores the transdermal approach as a viable strategy for addressing various types of cancer. This work also explores into the delivery of peptides and proteins along with in-depth explanations of different delivery systems currently under investigation for localized skin cancer treatment. Furthermore, the review discusses the formidable challenges that must be surmounted before these innovations can find their way into clinical practice, offering a roadmap for future research and therapeutic development.

National Trends in Healthcare Expenditures for the Management of Skin Cancer in the United States

BACKGROUND

Malignant melanoma and keratinocyte carcinomas account for a substantial proportion of healthcare expenditures in the United States.

OBJECTIVE

To estimate trends in the economic burden of skin cancer in the United States between 1996 and 2016.

METHODS

The Disease Expenditure Project and Global Burden of Disease databases were used to estimate annual total costs and population-standardized rates of change for skin cancer-related healthcare spending.

RESULTS

Skin cancer expenditures totaled $23.4 billion in 2016, of which $1.4 billion (95% CI: $1.3-$1.6 billion) was melanoma-related and $22 billion (95% CI: $18-$28 billion) was keratinocyte carcinoma-related. Most spending on skin cancer management occurred in ambulatory care settings [60.7% (95% CI: 57.7%-64.3%) for melanoma and 87.8% (95% CI: 87.2%-88.2%) for keratinocyte carcinoma]. Pharmaceutical costs for melanoma have increased since 2010 to $365 million (95% CI: $327-$416 million), which represents 26.1% (95% CI: 22.6%-29.3%) of total melanoma expenditure.

CONCLUSIONS

Skin cancer management in the United States is costly. Expenditures have increased substantially since 1996 without signs of plateauing in recent years.

Global, regional, and national burden of cutaneous malignant melanoma from 1990 to 2021 and prediction to 2045

Background

Cutaneous Malignant Melanoma (CMM) is a significant global health challenge. Understanding regional differences in CMM prevalence and trends is crucial for developing targeted strategies. To address this, we analyzed epidemiological patterns and investigated risk factors for CMM-related mortality.

Methods

This study analyzed CMM using data from the 2021 Global Burden of Diseases survey, covering 204 countries and territories. We evaluated the number and age-standardized rates of prevalence (ASPR), mortality (ASMR), disability-adjusted life years (ASDR), and annual percentage changes (EAPCs). Trends were stratified by region, country, age, sex, and Sociodemographic Index (SDI). A Bayesian Age-Period-Cohort model projected future prevalence, mortality, and DALYs, while decomposition analysis identified key drivers of CMM burden. Frontier analysis further associated CMM outcomes with socio-demographic development.

Results

In 2021, the global prevalence of CMM reached 833,215 cases, a 161.3% increase since 1990. During this period, the ASPR rose from 19.13 to 25.37 per 100,000, while the ASMR declined from 0.84 to 0.73 per 100,000. DALYs increased by 60.5%, from 1,045,777 to 1,678,836. The high SDI region had the highest ASPR, ASMR, and ASDR. Decomposition analysis identified population growth, demographic aging, and epidemiological changes as equal drivers of CMM DALYs globally. Countries like New Zealand and Australia demonstrated the most significant effective differences, indicating potential for improvement in CMM management. By 2045, the global ASPR is projected to rise to 36.61, with ASMR and ASDR expected to decrease to 0.79 and 10.21 per 100,000.

Conclusion

CMM poses an increasing global health concern, with ASPR steadily rising. While this analysis shows a decline in global ASMR and ASDR overall, these rates are actually increasing in low SDI regions, and projections indicate that this trend will likely continue until 2045.

Enhanced Expression of N-Cadherin, but Not of E-Cadherin, in Cutaneous Squamous Cell Carcinoma in Comparison to Basal Cell Carcinoma

BACKGROUND

Adhesion molecules including E-cadherin and N-cadherin have been proven to contribute to the carcinogenesis process. It has been demonstrated that an increased expression or appearance of N-cadherin, as well as a reduction in the expression of E-cadherin, are documented in many cancers, often leading to the loss of intercellular adhesion and acquisition of a more invasive or even metastatic mesenchymal phenotype. The aim of this study was to assess the expression of E-cadherin and N-cadherin, as well as markers of proliferation Ki67 in basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

METHODS

A total of 123 tumor paraffin specimens, including 73 BCC and 50 SCC cases, were obtained from multiple anatomical locations. The expression of E-Cadherin and N-Cadherin, including the percentage of stained cells, was assessed using a four-grade scale, with Ki-67 assessed on the five-grade scale.

RESULTS

A significantly higher expression of N-cadherin was observed in SCC compared to BCC, with 14% of SCC cases having a more than 50% expression of N-cadherin, and 10% with 26-50% expression, in comparison with 2.7% and 8.2% in BCC, respectively (p < 0.001). No significant differences were observed with regard to E-cadherin expression between SCC and BCC.

CONCLUSIONS

Our results suggest that N-cadherin expression might contribute to the acquisition of the mesenchymal phenotype, SCC, when compared with BCC, with a high expression of E-cadherin in both tumors explaining their overall low rate of metastases; however, further research on the role of adhesion molecules in these tumors is needed.

Treatment and Prevention of HPV-Associated Skin Tumors by HPV Vaccination

HPV-associated dermatological diseases include benign lesions like cutaneous warts and external genital warts. In addition, HPV infection is associated with the development of epithelial skin cancers, in particular cutaneous squamous cell carcinoma (cSCC). In contrast to anogenital and oropharyngeal cancers caused by mucosal HPV types of genus alpha papillomavirus, cSCC-associated HPV types belong to the genus beta papillomavirus. Currently available HPV vaccines that target mucosal HPV types associated with anogenital cancer and genital warts are type-specific and provide no cross-protection against beta HPV. When implementing vaccination to beta HPV to prevent skin tumors, it must be considered that acquisition of these HPV types occurs early in childhood and that the risk for cSCC increases with growing age and decreasing immune surveillance. Thus, individuals considered for beta HPV vaccination usually have pre-existing infection and are largely immunocompromised. On the other hand, worldwide increasing incidence rates of epithelial skin cancer reflect an urgent need for skin cancer prevention measures. Based on the pathogenic involvement of beta HPV, vaccination may represent a promising prevention strategy. Indeed, various procedures of prophylactic and therapeutic vaccination have been developed, and some of them have shown efficiency in animal models. Thus far, however, none of these vaccine candidates has been approved for application in humans.

Squamous cell carcinoma arising in chronically damaged skin (Marjolin's Ulcer): still an unmet need in the era of immunotherapy

BACKGROUND

Cutaneous squamous cell carcinoma (cSCC) is characterized by a high tumor mutational burden due to solar damage and a favorable response to anti-PD-1 immunotherapy. Yet, we encounter tumors arising in areas with minimal sun exposure, such as cSCC that develops in chronically inflamed skin, also known as Marjolin's Ulcer (MU). The response of MU-SCC to immunotherapy remains unknown.

METHODS

We performed a retrospective analysis of patients diagnosed with cSCC and treated with cemiplimab or pembrolizumab in a single tertiary medical center. Patients lost to follow up were excluded.

RESULTS

Of the 84 eligible patients, 9 (11%) had MU-SCC. Of these, 2 (22%) reached partial response (PR), and none reached complete response (CR). In contrast, of the 75 patients with solar damage-related cSCC, 40 had PR (53%), and 20 had CR (26%). The difference between the two subtypes was significant (P < .001). Interestingly, 3 patients with MU-SCC received a second-line chemo-immunotherapy and experienced a partial response that continued for 5 to 21 months. Patients with MU-SCC had a significantly shorter median time to progression (TTP) (1.6 vs 51.6 months, P < .001) and progression-free survival (PFS) (1.6 vs 15.4 months, P < .001). Overall survival (OS) was not significantly shorter (17.4 vs 36.7 months, P = .096). Multivariate analysis confirmed that MU-SCC is an independent risk factor for shorter TTP (HR 5.5, 95% CI 2.2-14.0, P < .001) and PFS (HR 3.5, 95% CI 1.5-8.1, P = .003).

CONCLUSIONS

This study suggests that immunotherapy is less beneficial in SCC-MU. More work is needed to verify our findings and explore other treatment options.

Use of Total Auricular Fillet Flap to Reconstruct Defects After Auricular and Parotid Region Tumors

PURPOSE

The auricular fillet flap (AFF) is also used to reconstruct defects of the periauricular region and scalp.The aim of this study was to evaluate patients in whom the total AFF was used to reconstruct defects formed after the resection the skin of the auricular and parotid regions.

METHODS

Seven patients, who presented at the researchers' hospital between January 2017 and July 2020 with masses involving, to different degrees, the parotid region, the periauricular region, the external auditory canal, or the auricular anterior surface skin were retrospectively evaluated.

RESULTS

The study retrospectively analyzed seven patients aged 71 to 92 (mean: 80.3 years), including two females (28.5%) and five males (71.5%). The defective region, formed as a result of surgery, was reconstructed with the TAFF in all patients. One patient developed a blood circulation deficiency at first but recovered within a week, while there were no problems with blood circulation or compatibility of the flaps in the other six patients.

CONCLUSION

The researchers recommend using the TAFF as an alternative flap for reconstructing defects of the skin of the auricular and parotid regions. This reconstruction method can be achieved in one session and offers acceptable aesthetic results.

False Positive Rate from Prospective Studies of PET-CT in Cutaneous Malignant Melanoma: A Systematic Review and Meta-Analysis

BACKGROUND

Cutaneous malignant melanoma (CMM) is increasing in prevalence and possesses the highest mortality rate of any skin cancer. Positron Emission Tomography and Computed Tomography (PET-CT) may be utilised in either radiological staging or surveillance, primarily in stage III-IV disease. False positive (FP) results lead to patient distress, increased costs, and unnecessary follow-up. The FP rate in CMM literature varies widely, altering calculations of positive predictive value and has not undergone pooled meta-analytic.

MATERIALS AND METHODS

A systematic review and meta-analysis of FP results in prospective studies of PET-CT in CMM was performed in accordance with PRISMA guidelines.

RESULTS

The systematic review produced 14 trials for inclusion. Patient-based reporting had the lowest pooled proportion of FP results with 5.8 % (95 % CI = 3.3 % to 8.8 %), lesion-based was highest with 9.1 % (95 % CI = 3.4 % to 17.2 %) and combined was 6.1 % (95 % CI = 4.3 % to 8.1 %). Bias was low to unclear other than for FP reporting. Heterogeneity (I2) was variable across all analyses. FP findings were mainly lymphatic, dermatological, respiratory, or skeletal. Diagnostic information was not provided.

CONCLUSIONS

This study was the first attempt to quantify the pooled proportion of FP results from PET-CT in CMM. A small number of studies (n = 14) were available due to the predominance of retrospective methodology. Due to inconsistent reporting the true proportion of FP results is unclear. Systemic distribution was expected but limited diagnostic information was provided. Repeat meta-analysis using retrospective work should be performed. Future work should be prospective with clearly documented FP proportion, distribution, diagnosis, and follow-up.

Unraveling the landscape of non-melanoma skin cancer through single-cell RNA sequencing technology

Non-melanoma skin cancer (NMSC) mainly includes basal cell carcinoma, cutaneous squamous cell carcinoma, and Merkel cell carcinoma, showing a low mortality rate but the highest incidence worldwide. In recent decades, research has focused on understanding the pathogenesis and clinical treatments of NMSC, leading to significant advances in our knowledge of these diseases and the development of novel therapies, including immunotherapy. Nevertheless, the low to moderate objective response rate, high recurrence, and therapeutic resistance remain persistent challenges, which are partly attributable to the intratumoral heterogeneity. This heterogeneity indicates that tumor cells, immune cells, and stromal cells in the tumor microenvironment can be reshaped to a series of phenotypic and transcriptional cell states that vary in invasiveness and treatment responsiveness. The advent of single-cell RNA sequencing (scRNA-seq) has enabled the comprehensive profiling of gene expression heterogeneity at the single-cell level, which has been applied to NMSC to quantify cell compositions, define states, understand tumor evolution, and discern drug resistance. In this review, we highlight the key findings, with a focus on intratumoral heterogeneity and the mechanism of drug resistance in NMSC, as revealed by scRNA-seq. Furthermore, we propose potential avenues for future research in NMSC using scRNA-seq.

Evaluating the Impact of a Virtual Skin Cancer Awareness Workshop for 16-19-Year-Olds

Introduction  The incidence of malignant melanoma (MM) in the United Kingdom (UK) has significantly increased in recent years and is expected to continue to rise over the next decade. Despite the preventable nature of most MM cases, existing evidence suggests that public health education around skin cancer and sun safety is often suboptimal, particularly for secondary school populations. Unlike primary school curricula, there is no national guidance to mandate the teaching of this topic in secondary school. Early intervention through education can encourage sun-safe practices, and therefore potentially reduce the risk of MM developing. The primary aim of this study was to improve awareness of skin cancer, including its risk factors and preventive measures, amongst sixth-form students.  Methods  An online workshop was organised by In2MedSchool, a national widening access charitable scheme for aspiring medical students, in collaboration with the Karen Clifford Skin Cancer Charity. Plan-Do-Study-Act methodology was utilised to design and evaluate a skin cancer awareness and sun safety workshop. It addressed key topics such as MM risk factors, preventive measures, and the widely used 'ABCDE' assessment of MM. A total of 73 students from across the UK attended the virtual workshop. To maximise engagement, visual aids, low-stakes quizzing, and an interactive chat function were utilised.  Participants completed anonymous pre- and post-intervention questionnaires, assessing their confidence and knowledge in understanding skin cancer risk factors and sun-safe behaviours. Confidence levels were measured using a seven-point Likert scale, and knowledge was evaluated through a ten-question assessment. Statistical analyses, including averages, medians, interquartile ranges (IQR), and Wilcoxon signed-rank tests were performed to assess the changes in participants' knowledge and confidence.  Results  Before the intervention, participants reported an average confidence score of 4.07 in understanding skin cancer risk factors, which significantly improved to 6.39 after the workshop, representing a 57.09% increase (p < 0.00001). Confidence in applying protective measures increased by 45.67%, from 4.51 to 6.57 (p < 0.00001). In addition, most students expressed feeling underprepared by existing sun safety programs at both primary and secondary school levels.  Knowledge assessments demonstrated significant improvement, with average scores increasing from 7.49 pre-intervention to 9.10 post-intervention (21.46% improvement, p < 0.00001). The median score increased from 8 (IQR: 3) to 9 (IQR: 1) following the workshop, demonstrating a notable increase in understanding of skin cancer risk factors, protective behaviours, and early detection methods.  Conclusion  Our findings indicate that many secondary school students feel unprepared regarding existing skin cancer awareness and sun safety programs in school. This study provides evidence to suggest that targeted, interactive workshops have the potential to improve awareness and knowledge of this important topic in the short term. However, participants in this cohort are likely to have an established interest in medicine and healthcare, beyond that of their wider peer group. This limits the broader application of our findings. Further research that explores the longer-term impact of such interventions, including changes in attitudes and behaviours, is recommended.

Phytosynthesis, Characterization, Phenolic and Biological Evaluation of Leptadenia pyrotechnica-Based Zn and Fe Nanoparticles Utilizing Two Different Extraction Techniques

Introduction

Phyto-nanotechnology offers a sustainable method for synthesizing biocompatible metal nanoparticles (NPs) with therapeutic potential. The diverse medicinal flora in the UAE, particularly Leptadenia pyrotechnica (LP), provides a vital resource for advancing this research area. This plant is historically valued in the region for its wide medicinal applications due to its abundance of bioactive compounds.

Methods

In this study, eco-friendly, straightforward, and low-temperature hydrothermal synthesis methods were applied to synthesize potentially therapeutic Zn and Fe NPs using LP extracts. The generated NPs were characterized using UV-VIS, FT-IR, SEM, EDX, XRD and DLS. Moreover, they were investigated for their total phenolic and flavonoid contents, along with their antioxidant and skin anticancer effects.

Results

The UV-Vis spectra disclosed absorption band at about 275 nm, and the FT-IR confirmed the successful coating of the NPs with the plants' phytochemicals, thus ensuring the successful bio-fabrication of the proposed NPs. SEM/EDX outcomes suggest a more potent reducing effect of the aqueous extract, while a more effective coating of the alcoholic extract. DLS revealed monodispersed NPs, with average sizes ranging from 43.82 to 207.8 nm. LFeC demonstrated the highest phenolic and flavonoid contents (49.96±4.76 μg of GAE/mg of DW and 43.89±2.89 μg of Qu/mg of DW, respectively) and the greatest potency against skin cancer cell lines (IC50=263.56 µg/mL). However, LZnC exhibited the strongest radical scavenging effect against DPPH and ABTS radicals (IC50=139.45µg/mL and 35.1µg/mL, respectively).

Discussion

The results of this study demonstrated that both extracts of LP are effective in the green synthesis of Fe and Zn nanoparticles for biomedical applications, with alcoholic extracts providing superior coating, capping, and stabilizing properties, leading to lower agglomeration, higher carbon content, total phenolic and flavonoid contents, along with enhanced anticancer and antioxidant effects. This work gives a showcase of sustainable materials that are promising for therapeutic applications.

Unveiling the chemotherapeutic potential of two platinum(IV) complexes in skin cancer: in vitro and in vivo Insights

The present study investigates the chemotherapeutic potential of two platinum (IV) complexes, P-PENT and P-HEX, against skin cancer in vitro and in vivo. Both complexes exhibited potent cytotoxicity against HaCaT-II-4 cells with IC50 values of 0.8 ± 0.08 μM and 1.3 ± 0.16 μM respectively, while demonstrating 8-10-fold selectivity compared to mesenchymal stem cells (MSCs). Western blot analysis revealed significant modulation of key apoptotic and survival pathways, including upregulation of Bax/Bcl2 ratio, cleaved caspase 3, and cytochrome c, suggesting induction of intrinsic apoptosis. The complexes also inhibited PI3K and MAPK pathways, as evidenced by decreased p-AKT/AKT and p-ERK/ERK ratios. Flow cytometry confirmed significant apoptotic cell death. Both complexes also increased reactive oxygen species production. In a DMBA/TPA-induced skin carcinogenesis mouse model, both complexes significantly suppressed tumor growth at doses considerably lower than the maximum tolerated dose, with no detectable toxicity. A dose escalation study in BALB/c mice showed that P-PENT and P-HEX were approximately 5-fold and 4-fold more tolerated than cisplatin, respectively. In conclusion, the present study provides evidence that P-PENT and P-HEX may have the characteristics of an effective and potentially safe anti-tumor drug that could be used in skin cancer treatment.

Advancements in skin cancer treatment: focus on photodynamic therapy: a review

Some of these include basal cell carcinoma (BCCs), squamous cell carcinoma (SCCs), and melanoma; skin cancer is a leading global health problem due to its high prevalence and possibly due to its serious health implications. Conventional and known therapies like surgeries, radiation therapies and chemotherapy although helpful are sometime deleterious and do not specifically attack the cancers. New advancement is half-breed technique has recently been recognized that photodynamic therapy (PDT) can be considered as a potentially effective modality by using photosensitizers which work through the generation of localized ROS on exposure to light. This review analyzes the recent progress in PDT and evaluation of its effectiveness in the cure of skin malignancies: with the emphasis on its applicability to BCCs and SCCs, as well as the limitations concerning the cure of melanomas. This review gives an insight to how PDT works and how it can be combined with other forms of therapy, and the prospects of photosensitizer carriers with special reference to nanotechnology. Also, the optimization of the parameters associated with the use of PDT is explored in an attempt to improve on its safety and efficacy in treatment. As such, the purpose of this systematic review of the literature is to advance the knowledge of PDT usage in contemporary dermatologic oncology and to contribute to the eventual expansion of this therapy into other skin diseases and potential use as a first-line treatment for skin neoplasia.

Autophagy as a targeted therapeutic approach for skin cancer: Evaluating natural and synthetic molecular interventions

Skin cancer, a prevalent malignancy worldwide, poses significant health concerns owing to its increasing incidence. Autophagy, a natural cellular process, is a pivotal event in skin cancer and has advantageous and detrimental effects. This duality has prompted extensive investigations into medical interventions targeting autophagy modulation for their substantial therapeutic potential. This systematic review aimed to investigate the relationship between skin cancer and autophagy and the contribution and mechanism of autophagy modulators in skin cancer. We outlined the effectiveness and safety of targeting autophagy as a promising therapeutic strategy for the treatment of skin cancer. This comprehensive review identified a diverse array of autophagy modulators with promising potential for the treatment of skin cancer. Each of these compounds demonstrates efficacy through distinct physiological mechanisms that have been elucidated in detail. Interestingly, findings from a literature search indicated that none of the natural, synthetic, or semisynthetic compounds exhibited notable adverse effects in either human or animal models. Consequently, this review offers novel mechanistic and therapeutic perspectives on the targeted modulation of autophagy in skin cancer.

The National Cancer Aid monitoring (NCAM-online) of ultraviolet radiation risk and protection behavior: a population-based observational trend study with four annual online survey waves

BACKGROUND

Ultraviolet (UV) radiation is the most important risk factor for skin cancer development. Sunlight is the main source of UV radiation in the general population. In addition, tanning beds are a source of artificial UV radiation. Since the incidence of skin cancer is increasing worldwide, it is necessary to monitor UV-related risk behaviors such as intentional indoor and outdoor tanning, as well as sun protection behavior in the general population and specific subgroups and settings. This is the aim of the National Cancer Aid Monitoring online (NCAM-online), a continuation and further development of the NCAM.

METHODS

The NCAM-online is a longitudinal trend study consisting of four annual survey waves. Each year, 4,000 individuals aged 16-65 years living in Germany will be surveyed using online questionnaires. Each year, intentional indoor and outdoor tanning will be assessed. In addition, varying specific topics regarding skin cancer prevention, such as the utilization of skin cancer screening, will be addressed in the questionnaires.

DISCUSSION

The findings of the NCAM-online will provide an important basis for the German Cancer Aid and Working Group on Dermatologic Prevention (Arbeitsgemeinschaft Dermatologische Prävention, ADP) to develop targeted prevention campaigns and projects aimed at preventing skin cancer. The explorative nature of the NCAM-online allows for the identification of new potential starting points for prevention and education. In addition, the longitudinal design allows for a description of the trend in the prevalence of intentional tanning. For tanning bed use, representative trend data from 2012 are available for Germany, to which NCAM-online will add annual data until 2027.

Efficient skin lesion segmentation with boundary distillation

Medical image segmentation models are commonly known for their complex structures, which often render them impractical for use on edge computing devices and compromising efficiency in the segmentation process. In light of this, the industry has proposed the adoption of knowledge distillation techniques. Nevertheless, the vast majority of existing knowledge distillation methods are focused on the classification tasks of skin diseases. Specifically, for the segmentation tasks of dermoscopy lesion images, these knowledge distillation methods fail to fully recognize the importance of features in the boundary regions of lesions within medical images, lacking boundary awareness for skin lesions. This paper introduces pioneering medical image knowledge distillation architecture. The aim of this method is to facilitate the efficient transfer of knowledge from existing complex medical image segmentation networks to a more simplified student network. Initially, a masked boundary feature (MBF) distillation module is designed. By applying random masking to the periphery of skin lesions, the MBF distillation module obliges the student network to reproduce the comprehensive features of the teacher network. This process, in turn, augments the representational capabilities of the student network. Building on the MBF distillation module, this paper employs a cascaded combination approach to integrate the MBF distillation module into a multi-head boundary feature (M2BF) distillation module, further strengthening the student network's feature learning ability and enhancing the overall image segmentation performance of the distillation model. This method has been experimentally validated on the public datasets ISIC-2016 and PH2, with results showing significant performance improvements in the student network. Our findings highlight the practical utility of the lightweight network distilled using our approach, particularly in scenarios demanding high operational speed and minimal storage usage. This research offers promising prospects for practical applications in the realm of medical image segmentation.

Retrospective study of postoperative survival of keratinocyte-derived skin cancer patients at the end of life

BACKGROUND AND OBJECTIVES

Basal and squamous cell carcinoma (BCC, SCC), collectively referred to as keratinocyte-derived skin cancer (KC), are the most common human cancers worldwide. Surgery is the treatment of choice, but may represent overtreatment in the very elderly. This study aims to address this issue by investigating the life expectancy of patients over 80 years after surgery.

PATIENTS AND METHODS

A single-center, retrospective study was performed to include surgically treated KC patients at the Department of Dermatology and Venereology of the University Hospital in St. Pölten, Austria, between 01.01.2011 and 31.12.2017, who were 80 years or older. Data on individual survival (cut-off April 30, 2020), date and cause of death were retrieved from the Austrian national demographic database at Statistics Austria (Vienna).

RESULTS

940 patients (450 female, 490 male, 639 BCCs, 301 SCCs) were included with 307 being alive at the cut-off date. Median postoperative survival was 57 months (95% CI, 54-63 months).

CONCLUSIONS

With a median postoperative survival of almost 5 years, surgery remains a valid treatment option for KC at the end of life. However, 77 of the treated patients died within a year after surgery and preoperative assessment might have helped to avoid overtreatment in some of these cases.

Evidence for Radiation Therapy in Stage III Locoregionally Advanced Cutaneous Melanoma in the Post-Immunotherapy Era: A Literature Review

In the landscape of Stage III locoregionally advanced cutaneous melanoma treatment, the post-immunotherapy era has sparked a number of questions on the management of the nodal basin. However, much of the available literature is not focused on radiation therapy as an adjuvant therapy. This literature review aims to illuminate the evidence surrounding radiation therapy's potential to mitigate regional recurrences in the adjuvant setting for melanoma. Additionally, it seeks to identify adjunct systemic therapy options and explore the synergy between systemic therapy and radiation. Despite strides in surgical techniques and systemic therapies, controlling regional Stage III melanoma remains a formidable clinical hurdle. While historical data strongly suggest the efficacy of adjuvant radiation therapy in reducing regional recurrence risk, its evaluation predates the advent of MAPK pathway inhibitors and robust immunotherapy options. Notably, clinical trials have yet to definitively demonstrate a survival advantage with adjuvant radiation therapy. Additional research should focus on refining the definition of high risk for regional recurrence through gene expression profiling or tumor immune profiling scores and elucidate the optimal role of adjuvant radiation therapy in patients treated with neoadjuvant systemic therapy.

The m-TORC1 inhibitor Sirolimus increases the effectiveness of Photodynamic therapy in the treatment of cutaneous Squamous Cell Carcinoma, impairing NRF2 antioxidant signaling

Squamous Cell Carcinoma (SCC) is a subtype of Non-Melanoma Skin Cancer, the most common group of malignancies worldwide. Photodynamic therapy (PDT) is a non-invasive treatment approved for specific subtypes of SCC. Some malignancies resist PDT, forming more aggressive tumors and multiple relapses. Thus, new approaches aimed at optimizing the response to PDT are needed. The mTORC1 inhibitor rapamycin, also known as Sirolimus (SRL), interferes with protein synthesis and cell metabolism. The use of SRL as an immunosuppressant is associated to lower rates of SCC in kidney-transplanted patients, which are frequently affected by this pathology. We have evaluated SRL pre-treatment efficacy to enhance the damage induced by PDT with Methyl 5-aminolevulinate in two different cutaneous SCC established cell lines (SCC13 and A431) in vitro and therapy sensitization in PDT-resistant cell lines. We tested for the first time the SRL + PDT combination in a SKH-1 mouse model of photocarcinogenesis, diminishing the frequency of lesions and restraining tumor growth. Molecular studies revealed that protoporphyrin IX and reactive oxygen species production induced by PDT were promoted by SRL pre-treatment. Lastly, SRL modifies the expression and intracellular location of NRF2, interfering with the downstream antioxidant response modulated by NQO1 and HO-1. In conclusion, we propose SRL as a potential adjuvant to enhance PDT efficacy for SCC treatment.

A keratinocyte-adipocyte signaling loop is reprogrammed by loss of BTG3 to augment skin carcinogenesis

Obesity is endemic to many developed countries. Overweight or obesity is associated with an increased risk of developing cancer. Dysfunctional adipose tissue alters cancer cell proliferation and migration; however, whether and how neoplastic epithelial cells communicate with adipose tissue and the underlying mechanism are less clear. BTG3 is a member of the anti-proliferative BTG/Tob family and functions as a tumor suppressor. Here, we demonstrated that BTG3 levels are downregulated in basal cell carcinoma and squamous cell carcinoma compared to normal skin tissue, and Btg3 knockout in mice augmented the development of papilloma in a mouse model of DMBA/TPA-induced skin carcinogenesis. Mechanistically, BTG3-knockout keratinocytes promoted adipocyte differentiation mainly through the release of IL1α, IL10, and CCL4, as a result of elevated NF-κB activity. These adipocytes produced CCL20 and FGF7 in a feedback loop to promote keratinocyte migration. Thus, our findings showcased the role of BTG3 in guarding the interplay between keratinocytes and adjacent adipocytes, and identified the underlying neoplastic molecular mediators that may serve as possible targets in the treatment of skin cancer.

Line-Field Confocal Optical Coherence Tomography for the Diagnosis of Skin Tumors: A Systematic Review and Meta-Analysis

A line-field confocal optical coherence tomography (LC-OCT) combines confocal microscopy and optical coherence tomography into a single, rapid, easy-to-use device. This meta-analysis was performed to determine the reliability of LC-OCT for diagnosing malignant skin tumors. PubMed, EMBASE, Web of Science databases, and the Cochrane Library were searched for research studies in the English language from inception till December 2023. To assess quality and the risk of bias, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used. The sensitivity and specificity of each study were calculated. The bivariate summary sensitivity and specificity were calculated using the linear mixed model. Five studies with 904 reported per lesion analyses in our study; the specificity and sensitivity ranged from 67% to 97% and 72% to 92%, respectively. The pooled specificity and sensitivity were 91% (95% CI: 76-97%) and 86.9% (95% CI: 81.8-90.8%), respectively. The summary sensitivity and specificity from the bivariate approach are 86.9% (95% CI: 81.8-90.8%) and 91.1% (95% CI: 76.7-97.0%), respectively. The area under the curve is 0.914. LC-OCT shows great sensitivity and specificity in diagnosing malignant skin tumors. However, due to the limited number of studies included in our meta-analysis, it is premature to elucidate the true potential of LC-OCT.

Ultraviolet Filters: Dissecting Current Facts and Myths

Skin cancer is a global and increasingly prevalent issue, causing significant individual and economic damage. UV filters in sunscreens play a major role in mitigating the risks that solar ultraviolet ra-diation poses to the human organism. While empirically effective, multiple adverse effects of these compounds are discussed in the media and in scientific research. UV filters are blamed for the dis-ruption of endocrine processes and vitamin D synthesis, damaging effects on the environment, induction of acne and neurotoxic and carcinogenic effects. Some of these allegations are based on scientific facts while others are simply arbitrary. This is especially dangerous considering the risks of exposing unprotected skin to the sun. In summary, UV filters approved by the respective governing bodies are safe for human use and their proven skin cancer-preventing properties make them in-dispensable for sensible sun protection habits. Nonetheless, compounds like octocrylene and ben-zophenone-3 that are linked to the harming of marine ecosystems could be omitted from skin care regimens in favor of the myriad of non-toxic UV filters.

The effect of hair removal and filtering on melanoma detection: a comparative deep learning study with AlexNet CNN

Melanoma is the most aggressive and prevalent form of skin cancer globally, with a higher incidence in men and individuals with fair skin. Early detection of melanoma is essential for the successful treatment and prevention of metastasis. In this context, deep learning methods, distinguished by their ability to perform automated and detailed analysis, extracting melanoma-specific features, have emerged. These approaches excel in performing large-scale analysis, optimizing time, and providing accurate diagnoses, contributing to timely treatments compared to conventional diagnostic methods. The present study offers a methodology to assess the effectiveness of an AlexNet-based convolutional neural network (CNN) in identifying early-stage melanomas. The model is trained on a balanced dataset of 10,605 dermoscopic images, and on modified datasets where hair, a potential obstructive factor, was detected and removed allowing for an assessment of how hair removal affects the model's overall performance. To perform hair removal, we propose a morphological algorithm combined with different filtering techniques for comparison: Fourier, Wavelet, average blur, and low-pass filters. The model is evaluated through 10-fold cross-validation and the metrics of accuracy, recall, precision, and the F1 score. The results demonstrate that the proposed model performs the best for the dataset where we implemented both a Wavelet filter and hair removal algorithm. It has an accuracy of 91.30%, a recall of 87%, a precision of 95.19%, and an F1 score of 90.91%.

Incidence and survival rates of primary cutaneous malignancies in Korea, 1999-2019: A nationwide population-based study

Primary cutaneous malignancies are among the most commonly diagnosed types of cancer worldwide. We aimed to examine the incidence and 5-year survival rates of all types of primary cutaneous malignancies in the Korean population. Data from the Korean Nationwide Cancer Registry from 1999 to 2019 were analyzed. The crude incidence rates, age-standardized incidence rates, and 5-year relative survival rates of each type of skin cancer were calculated. A total of 89 965 patients were diagnosed with primary cutaneous malignancies, which was a 7-fold increase from 1999 to 2019. The age-standardized incidence rates increased 3.4-fold in basal cell carcinoma (3.7/100 000 person-years), 2.0-fold in squamous cell carcinoma (1.6/100 000 person-years), 12.0-fold in Bowen disease (1.2/100 000 person-years), and 1.8-fold in malignant melanoma (0.7/10 000 person-years) in 2019. Average annual percentage changes in age-standardized incidence rates were statistically significant in basal cell carcinoma (15.8%), Bowen disease (5.8%), squamous cell carcinoma (5.1%), malignant melanoma (1.2%), melanoma in situ (1.1%), dermatofibrosarcoma protuberans (1.2%), mycosis fungoides (0.5%), primary cutaneous CD30+ T-cell proliferations (0.5%), adnexal and skin appendage carcinoma (0.4%), extramammary Paget's disease (0.2%), and Merkel cell carcinoma (0.2%). The 5-year relative survival rates were the highest in basal cell carcinoma (103.3%), followed by dermatofibrosarcoma protuberans (99.7%) and mycosis fungoides (96.6%), and lowest in angiosarcoma (24.7%). The 5-year relative survival rates steadily increased in extramammary Paget's disease (23.6%), cutaneous B-cell lymphoma (21.3%), mycosis fungoides (20.2%), extranodal NK/T-cell lymphoma, nasal type (18.1%), and malignant melanoma (16.1%) from 1996-2000 to 2015-2019. Most primary cutaneous malignancies have increased in incidence and survival rates in the Korean population, but to varying extents depending on the type of skin cancer.

Transcriptomics analysis of LINC02202/XBP1 axis in melanoma: Implications for drug targeting and PD-1 monoclonal antibody efficacy

Malignant melanoma (MM) is a highly aggressive and deadly form of skin cancer, primarily caused by recurrence and metastasis. Therefore, it is crucial to investigate the regulatory mechanisms underlying melanoma recurrence and metastasis. Our study has identified a potential targeted regulatory relationship between LINC02202, miR-526b-3p and XBP1 in malignant melanoma. Through the regulation of the miR-526b-3p/XBP1 signalling pathway, LINC02202 may play a role in tumour progression and immune infiltration and inhibiting the expression of LINC02202 can increase the efficacy of immunotherapy for melanoma. Our findings shed light on the impact of LINC02202/XBP1 on the phenotype and function of malignant melanoma cells. Furthermore, this study provides a theoretical foundation for the development of novel immunotherapy strategies for malignant melanoma.

Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality

BACKGROUND

whether screening for skin cancer affects melanoma-specific mortality in a population-based setting remains unclear.

METHODS

in this population-based cohort study, we characterized and evaluated a skin cancer prevention program following a targeted screening approach conducted in 1989-1994 in the Austrian province Vorarlberg, with follow-up until 2019. The general population and attendees of a health examination program served for comparison.

RESULTS

in the screening program including full follow-up until 2019, 207 invasive and 187 in situ melanomas were identified in 8997 individuals. Incidences of invasive and in situ melanomas were elevated compared to the general population (IRR 2.92, 95%-CI 2.49-3.41, and IRR 4.13, 95%-CI 3.53-4.83, respectively) and the health examination program (HR 3.02, 95%-CI 2.59-3.52, and HR 3.90, 95%-CI 3.30-4.61, respectively). Breslow thickness and Clark's level at time of invasive diagnosis were significantly lower in 1989-2019, but the tumor characteristics of the melanomas diagnosed during 1989-1994 did not differ from the comparison groups. Moreover, melanoma mortality was significantly elevated in the screening program (IRR 1.66, 95%-CI 1.00-2.75 vs. the general population, HR 2.12, 95%-CI 1.25-3.61 vs. the health examination cohort). Melanoma mortality in Vorarlberg declined until 2004, though statistically non-significantly.

CONCLUSIONS

given the uncertain effectiveness and high public expenditures of population-wide mass screening programs, primary prevention and targeted risk-based skin cancer screening might be promising alternatives.

Comparative response to PDT with methyl-aminolevulinate and temoporfin in cutaneous and oral squamous cell carcinoma cells

Cutaneous and Head and Neck squamous cell carcinoma (CSCC, HNSCC) are among the most prevalent cancers. Both types of cancer can be treated with photodynamic therapy (PDT) by using the photosensitizer Temoporfin in HNSCC and the prodrug methyl-aminolevulinate (MAL) in CSCC. However, PDT is not always effective. Therefore, it is mandatory to correctly approach the therapy according to the characteristics of the tumour cells. For this reason, we have used cell lines of CSCC (A431 and SCC13) and HNSCC (HN5 and SCC9). The results obtained indicated that the better response to MAL-PDT was related to its localization in the plasma membrane (A431 and HN5 cells). However, with Temoporfin all cell lines showed lysosome localization, even the most sensitive ones (HN5). The expression of mesenchymal markers and migratory capacity was greater in HNSCC lines compared to CSCC, but no correlation with PDT response was observed. The translocation to the nucleus of β-catenin and GSK3β and the activation of NF-κβ is related to the poor response to PDT in the HNSCC lines. Therefore, we propose that intracellular localization of GSK3β could be a good marker of response to PDT in HNSCC. Although the molecular mechanism of response to PDT needs further elucidation, this work shows that the most MAL-resistant line of CSCC is more sensitive to Temoporfin.

Regulation of Cell Cycle Progression through RB Phosphorylation by Nilotinib and AT-9283 in Human Melanoma A375P Cells

BCR-ABL tyrosine kinase inhibitors are commonly employed for the treatment of chronic myeloid leukemia, yet their impact on human malignant melanoma remains uncertain. In this study, we delved into the underlying mechanisms of specific BCR-ABL tyrosine kinase inhibitors (imatinib, nilotinib, ZM-306416, and AT-9283) in human melanoma A375P cells. We first evaluated the influence of these inhibitors on cell growth using cell proliferation and wound-healing assays. Subsequently, we scrutinized cell cycle regulation in drug-treated A375P cells using flow cytometry and Western blot assays. Notably, imatinib, nilotinib, ZM-306416, and AT-9283 significantly reduced cell proliferation and migration in A375P cells. In particular, nilotinib and AT-9283 impeded the G1/S transition of the cell cycle by down-regulating cell cycle-associated proteins, including cyclin E, cyclin A, and CDK2. Moreover, these inhibitors reduced RB phosphorylation, subsequently inhibiting E2F transcriptional activity. Consequently, the expression of the E2F target genes (CCNA2, CCNE1, POLA1, and TK-1) was markedly suppressed in nilotinib and AT9283-treated A375P cells. In summary, our findings suggest that BCR-ABL tyrosine kinase inhibitors may regulate the G1-to-S transition in human melanoma A375P cells by modulating the RB-E2F complex.

Designing, cloning and simulation studies of cancer/testis antigens based multi-epitope vaccine candidates against cutaneous melanoma: An immunoinformatics approach

Background

Melanoma is the most fatal kind of skin cancer. Among its various types, cutaneous melanoma is the most prevalent one. Melanoma cells are thought to be highly immunogenic due to the presence of distinct tumor-associated antigens (TAAs), which includes carcinoembryonic antigen (CEA), cancer/testis antigens (CTAs) and neo-antigens. The CTA family is a group of antigens that are only expressed in malignancies and testicular germ cells.

Methods

We used integrative framework and systems-level analysis to predict potential vaccine candidates for cutaneous melanoma involving epitopes prediction, molecular modeling and molecular docking to cross-validate the binding affinity and interaction between potential vaccine agents and major histocompatibility molecules (MHCs) followed by molecular dynamics simulation, immune simulation and in silico cloning.

Results

In this study, three cancer/testis antigens were targeted for immunotherapy of cutaneous melanoma. Among many CTAs that were studied for their expression in primary and malignant melanoma, NY-ESO-1, MAGE1 and SSX2 antigens are most prevalent in cutaneous melanoma. Cytotoxic and Helper epitopes were predicted, and the finest epitopes were shortlisted based on binding score. The vaccine construct was composed of the four epitope-rich domains of antigenic proteins, an appropriate adjuvant, His tag and linkers. This potential multi-epitope vaccine was further evaluated in terms of antigenicity, allergencity, toxicity and other physicochemical properties. Molecular interaction estimated through protein-protein docking unveiled good interactions characterized by favorable binding energies. Molecular dynamics simulation ensured the stability of docked complex and the predicted immune response through immune simulation revealed elevated levels of antibodies titer, cytokines, interleukins and immune cells (NK, DC and MA) population.

Conclusion

The findings indicate that the potential vaccine candidates could be effective immunotherapeutic agents that modify the treatment strategies of cutaneous melanoma.

Patient Satisfaction Following Primary Closure or Second Intention Healing After Conventional Nasal Skin Cancer Excision: A Cross-sectional Cohort Study

BACKGROUND

Nasal reconstruction after conventional surgical excision (CSE) of nonmelanoma skin cancer (NMSC) can be challenging. After excision and before the pathologic report, a simple reconstruction is favored. Yet, little is known about patient satisfaction after primary closure and second intention healing.

OBJECTIVE

Patient satisfaction after nasal defect reconstruction with primary closure or second intention healing, using the FACE-Q Skin Cancer.

METHODS

All patients who underwent CSE of nasal NMSC with immediate primary closure or second intention healing between March 2018 and March 2020 at Máxima Medisch Centrum Veldhoven were identified and asked to complete the FACE-Q Skin Cancer.

RESULTS

Of 183 patients, 140 patients completed the questionnaire. Fifty-five defects were closed by primary closure (38.5%) and 88 by second intention healing (61.5%). Thirty-one complications were reported (16.7%), of which 87.1% ( n = 27) after second intention healing ( p = .004). Both groups experienced high facial and scar satisfaction, low appearance-related distress, and no to minimal adverse effects. Second intention healing had 2.7 higher odds of achieving the maximum scar satisfaction score ( p = .02).

CONCLUSION

This study shows high satisfaction on facial and scar appraisal, low appearance-related distress, and no to minimal adverse effects for second intention healing and primary closure after CSE of nasal NMSC.

A new eco-friendly and water-resistant sunscreen agent: Lecithin-based multilamellar liposomes

BACKGROUND

UV skin exposure is an important matter of public health, as the worldwide rising prevalence of skin cancers indicates. However, a wide majority of commercially available sunscreens are responsible for ocean ecosystem damages such as coral reef degradation and phytoplankton mortality.

AIMS

To answer the urge for new eco-friendly UV filters, we studied the use of lecithin-based multilamellar liposomes (MLLs) of controlled size and elasticity as a bio-sourced and biodegradable alternative to classic sunscreens. These parameters control allows different skin layers targeting.

METHODS

The performance of two different MLLs compositions and a commercially available SPF50+ water-resistant liposomal sunscreen was compared on skin explants. SC-MLLs target the stratum corneum and Epi-MLLs the whole epidermis. Preparations were applied prior to skin irradiation. Their efficiencies were evaluated histologically (hematoxylin and eosin staining plus cyclobutane pyrimidine dimer [CPD] immunostaining) and by skin barrier quality assessment (trans-epithelial electrical resistance). Adhesiveness to the skin was also investigated.

RESULTS

Altogether, ex vivo results indicate MLLs offer a solar protection as effective as a SPF50+ water-resistant liposomal sunscreen but with a better skin adhesiveness and an improved skin barrier function.

CONCLUSION

Lecithin-based MLLs of controlled physicochemical parameters can be used as a new eco-friendly and water-resistant agent for solar protection. The stratum corneum targeted action of SC-MLLs appears to be more interesting, as SC-MLLs exhibit an overall better performance than Epi-MLLs at a lower cost. The skin barrier improvement showcased could be of interest to people suffering from dry skin or skin barrier impairment related disease.

Real-World Use of Ruxolitinib Cream: Safety Analysis at 1 Year

BACKGROUND

Ruxolitinib cream is the first topical Janus kinase (JAK) inhibitor approved in the United States (US) for the treatment of mild to moderate atopic dermatitis and nonsegmental vitiligo. A postmarketing study with oral tofacitinib, approved for rheumatoid arthritis, triggered class warnings for JAK inhibitors, including risk of serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis. Because ruxolitinib cream is indicated for inflammatory conditions, it is subject to the same warnings as oral JAK inhibitors in the US. Here, nearly 14,000 patient-years of postmarketing safety data from the first year following market approval of ruxolitinib cream were reviewed.

METHODS

The Incyte global safety database (21 September 2021-20 September 2022) and US FDA Adverse Event Reporting System (as of 30 September 2022) were queried for adverse event (AE) reports received for ruxolitinib cream.

RESULTS

The search identified 294 postmarketing individual case safety reports containing 589 events, including four serious AEs and no fatal AEs. AEs (i.e., any unfavorable sign, symptom, or disease) representing >2% of all events included application site pain (n = 16), atopic dermatitis (n = 15), skin irritation (n = 15), scratch (n = 14), and condition aggravated (n = 13). The four serious AEs were skin cancer (n = 2), pericarditis, and thrombocytopenia (both n = 1), none of which had sufficient information to assess possible relatedness to ruxolitinib cream. Serious AEs associated with the class warnings for JAK inhibitors were not reported.

CONCLUSIONS

Postmarketing safety data from the year following approval suggest ruxolitinib cream is generally well tolerated, without significant systemic AEs, and with a low incidence of application site reactions.

Optimized Ribociclib nanostructured lipid carrier for the amelioration of skin cancer: Inferences from ex-vivo skin permeation and dermatokinetic studies

Current research focuses on explicitly developing and evaluating nanostructured lipidic carriers (NLCs) for the chemotherapeutic drug Ribociclib (RCB) via the topical route to surmount the inherent bioavailability shortcomings. The absolute oral bioavailability has not been determined, but using a physiologically based pharmacokinetic model it was predicted that 65.8 % of the standard dose of RCB (600 mg) would be absorbed mainly in the small intestine. RCB-NLCs were produced using the solvent evaporation method, and Box-Behnken Design (BBD) was employed to optimize composition. The prepared NLCs had an average PS of 79.29 ± 3.53 nm, PDI of 0.242 ± 0.021, and a %EE of 86.07 ± 3.14. The TEM analysis disclosed the spherical form and non-aggregative nature of the NLCs. The outcomes of an in-vitro release investigation presented cumulative drug release of 84.97 ± 3.37 % in 24 h, significantly higher than that from the RCB suspension (RCB-SUS). Ex-vivo skin permeation investigations on rodent (Swiss albino mice) revealed that RCB-NLCs have 1.91 times increases in skin permeability comparable to RCB-SUS. Compared to RCB-SUS, RCB-NLCs were able to penetrate deeper into the epidermis membrane than RCB-SUS as per the findings of confocal microscopy. In dermatokinetic study, higher amount of RCB was maintained in both the layers of mice's skin when treated with RCB-NLCs gel comparable to the RCB-SUS gel preparation. The in-vitro, ex-vivo, CLSM, and dermatokinetics data demonstrated a significant possibility for this novel RCB formulation to be effective against skin cancer.

Isothiocyanates Potentiate Tazemetostat-Induced Apoptosis by Modulating the Expression of Apoptotic Genes, Members of Polycomb Repressive Complex 2, and Levels of Tri-Methylating Lysine 27 at Histone 3 in Human Malignant Melanoma Cells

In this study, we utilized an in vitro model consisting of human malignant melanoma as well as non-tumorigenic immortalized keratinocyte cells with the aim of characterizing the therapeutic effectiveness of the clinical epigenetic drug Tazemetostat alone or in combination with various isothiocyanates. In doing so, we assessed markers of cell viability, apoptotic induction, and expression levels of key proteins capable of mediating the therapeutic response. Our data indicated, for the first time, that Tazemetostat caused a significant decrease in viability levels of malignant melanoma cells in a dose- and time-dependent manner via the induction of apoptosis, while non-malignant keratinocytes were more resistant. Moreover, combinatorial treatment protocols caused a further decrease in cell viability, together with higher apoptotic rates. In addition, a significant reduction in the Polycomb Repressive Complex 2 (PRC2) members [e.g., Enhancer of Zeste Homologue 2 (EZH2), Embryonic Ectoderm Development (EED), and suppressor of zeste 12 (SUZ12)] and tri-methylating lysine 27 at Histone 3 (H3K27me3) protein expression levels was observed, at least partially, under specific combinatorial exposure conditions. Reactivation of major apoptotic gene targets was determined at much higher levels in combinatorial treatment protocols than Tazemetostat alone, known to be involved in the induction of intrinsic and extrinsic apoptosis. Overall, we developed an optimized experimental therapeutic platform aiming to ensure the therapeutic effectiveness of Tazemetostat in malignant melanoma while at the same time minimizing toxicity against neighboring non-tumorigenic keratinocyte cells.

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.

A Narrative Review of Current Knowledge on Cutaneous Melanoma

Cutaneous melanoma is a public health problem. Efforts to reduce its incidence have failed, as it continues to increase. In recent years, many risk factors have been identified. Numerous diagnostic systems exist that greatly assist in early clinical diagnosis. The histopathological aspect illustrates the grim nature of these cancers. Currently, pathogenic pathways and the tumor microclimate are key to the development of therapeutic methods. Revolutionary therapies like targeted therapy and immune checkpoint inhibitors are starting to replace traditional therapeutic methods. Targeted therapy aims at a specific molecule in the pathogenic chain to block it, stopping cell growth and dissemination. The main function of immune checkpoint inhibitors is to boost cellular immunity in order to combat cancer cells. Unfortunately, these therapies have different rates of effectiveness and side effects, and cannot be applied to all patients. These shortcomings are the basis of increased incidence and mortality rates. This study covers all stages of the evolutionary sequence of melanoma. With all these data in front of us, we see the need for new research efforts directed at therapies that will bring greater benefits in terms of patient survival and prognosis, with fewer adverse effects.

Recent Updates Regarding the Antiproliferative Activity of Galium verum Extracts on A375 Human Malignant Melanoma Cell Line

The biological activity of Galium verum herba was exerted on various tumor cell lines with incredible results, but their potential effect on malignant melanoma has not been established yet. Therefore, the current study was structured in two directions: (i) the investigation of the phytochemical profile of diethyl ether (GvDEE) and butanol (GvBuOH) extracts of G. verum L. and (ii) the evaluation of their biological profile on A375 human malignant melanoma cell line. The GvDEE extract showed an FT-IR profile different from the butanol one, with high antioxidant capacity (EC50 of GvDEE = 0.12 ± 0.03 mg/mL > EC50 of GvBuOH = 0.18 ± 0.05 mg/mL). The GvDEE extract also showed antimicrobial potential, especially against Gram-positive bacteria strains, compared to the butanol extract, which has no antimicrobial activity against any bacterial strain tested. The results regarding the antitumor potential showed that both extracts decreased A375 cell viability largely (69% at a dose of 55 µg/mL of the GvDEE extract). Moreover, both extracts induce nuclear fragmentation by forming apoptotic bodies and slight chromatin condensation, which is more intense for GvDEE. Considering the results, one can state that the Galium verum herba possesses antitumor effects on the A375 human malignant melanoma cell line, a promising phytocompound for the antitumor approach to skin cancer.

Diagnostic Performance of [18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients

We described the diagnostic performance of [18F]F-FDG-PET in malignant melanoma by conducting a comprehensive systematic review and meta-analysis of the existing literature. The study was designed following PRISMA-DTA. Original articles with adequate crude data for meta-analytic calculations that evaluated [18F]F-FDG-PET and compared it with a valid reference standard were considered eligible. The pooled measurements were calculated based on the data level (patient/lesion-based). Regarding sub-groups, diagnostic performances were calculated for local, regional and distant involvement. The bivariate model was employed to calculate sensitivity and specificity. The initial search resulted in 6678 studies. Finally, 100 entered the meta-analysis, containing 82 patient-based (10,403 patients) and 32 lesion-based (6188 lesions) datasets. At patient level, overall, [18F]F-FDG-PET had pooled sensitivity and specificity of 81% (95%CI: 73-87%) and 92% (95%CI: 90-94%), respectively. To detect regional lymph node metastasis, the pooled sensitivity and specificity were 56% (95%CI: 40-72%) and 97% (95%CI: 94-99%), respectively. To detect distant metastasis, they were 88% (95%CI: 81-93%) and 94% (95%CI: 91-96%), respectively. At lesion level, [18F]F-FDG-PET had a pooled sensitivity and specificity of 70% (95%CI: 57-80%) and 94% (95%CI: 88-97%), respectively. Thus, [18F]F-FDG-PET is a valuable diagnostic modality for melanoma assessment. It was accurate in various clinical scenarios. However, despite its high specificity, it showed low sensitivity in detecting regional lymph node metastasis and could not replace lymph node biopsy.

Recent Research Trends against Skin Carcinoma - An Overview

Skin cancer is a prevalent and sometimes lethal cancer that affects a wide range of people. UV radiation exposure is the main cause of skin cancer. Immunosuppression, environmental factors, and genetic predisposition are other contributing variables. Fair-skinned people and those with a history of sunburns or severe sun exposure are more likely to experience this condition. Melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) are the three main forms. Melanoma poses a bigger hazard because of its tendency for metastasis, while SCC and BCC have limited metastatic potential. Genetic mutations and changes to signalling pathways such as p53 and MAPK are involved in pathogenesis. Early diagnosis is essential, and molecular testing, biopsy, dermoscopy, and visual inspection can all help. In addition to natural medicines like curcumin and green tea polyphenols, treatment options include immunotherapy, targeted therapy, radiation, surgery, and chemotherapy. Reducing the incidence of skin cancer requires preventive actions, including sun protection and early detection programs. An overview of skin cancers, including their forms, pathophysiology, diagnosis, and treatment, highlighting herbal therapy, is given in this review.

Incidence of Non-Melanoma Skin Cancers in Salento (Southern Italy): A 15-Year Retrospective Analysis from the Cancer Registry of Lecce

BACKGROUND AND OBJECTIVES

Non-melanoma skin cancers (NMSCs) include basal cell carcinoma (BCC) and squamous-cell carcinoma (SCC), as well as a wide range of rare skin tumors. NMSCs is the most frequently diagnosed type of tumor among Caucasians. We aimed at estimating the incidence and mortality of NMSCs in the Salento area (Lecce province, Southern Italy), whose population is assumed to experience heavy and frequent sun exposure due to climatic/environmental factors, both for working and leisure activities.

MATERIALS AND METHODS

We computed the incidence of NMSCs in the Province of Lecce by examining the comprehensive real-world data collected by the local cancer registry, which covers all the 830,000 inhabitants, over a period of fifteen years (from 2003 to 2017), with a focus on the latest 5 years (2013-2017) for the analysis of the different histologic morphologies of these tumors. The incidence of NMSCs has been described in terms of absolute frequencies, crude rates and age-adjusted direct standardized rates (DSR). Joinpoint analysis was used to examine temporal trends in the incidence of NMSCs and estimate annual percent changes (APCs).

RESULTS

During the period of 2003-2017, the incidence of NMSCs reached a direct standardized rate (DSR) of 162.62 per 100,000 in men (mortality 1.57 per 100,000) and 89.36 per 100,000 in women (mortality 0.52 per 100,000), respectively. The incidence significantly increased among both men and women across the entire period. Basal cell carcinoma (BCC), with its different morphologies, represented about 67.6% of the NMSCs in men (n = 2139 out of a total of 3161 tumors observed between 2013 and 2017) and about 75.8% of the NMSCs in women (n = 1718 out of a total of 2264 tumors from 2013 to 2017), thus accounting for the vast majority of NMSCs. The results are consistent with the literature data carried out both at national and international level.

CONCLUSIONS

Proper monitoring of this phenomenon through timely reporting and recording of all new NMSC cases is necessary to develop new preventive strategies.