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Lapides R, Saravi B, Mueller A, Wang-Evers M, Maul LV, Németh I, Navarini A, Manstein D, Roider E. Possible Explanations for Rising Melanoma Rates Despite Increased Sunscreen Use over the Past Several Decades. Cancers (Basel) 2023; 15:5868. [PMID: 38136411 PMCID: PMC10741796 DOI: 10.3390/cancers15245868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
The incidence of cutaneous melanoma continues to rise despite the increased use of sunscreens within the last several decades. Some research even suggests that the use of sunscreen is associated with increased rates of melanoma. Given the aggressive, and often deadly, nature of cutaneous melanoma, the aim of this communication is to better elucidate the relationship between sunscreen use and melanoma development and if there are other preventative measures to be aware of. A search was performed to identify the studies that have investigated melanoma development in individuals who used sunscreen and those who did not. Study limitations and possible confounding variables were identified, which guided a subsequent search to determine what data were available to support that these limitations and confounding variables may explain the perplexing association between sunscreen use and melanoma development. Five hypotheses were generated, which were related to increased awareness and reporting, the relationship between sunscreen use and the duration of sun exposure, the importance of broad-spectrum protection, and the effect of sunscreen on reactive oxygen species formation. The main conclusion is that more recent studies that control for confounding variables are required to determine the true effect of adequate broad-spectrum sunscreen use today on the development of melanoma.
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Affiliation(s)
- Rebecca Lapides
- The Robert Larner, M.D., College of Medicine, University of Vermont, Burlington, VT 05405, USA;
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (M.W.-E.); (D.M.)
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Alina Mueller
- Department of Dermatology, University Hospital Basel, 4055 Basel, Switzerland; (A.M.); (L.V.M.); (A.N.)
| | - Michael Wang-Evers
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (M.W.-E.); (D.M.)
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, 4055 Basel, Switzerland; (A.M.); (L.V.M.); (A.N.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - István Németh
- Department of Dermatology and Allergology, Szent-Györgyi Albert Medical School, University of Szeged, 6720 Szeged, Hungary;
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, 4055 Basel, Switzerland; (A.M.); (L.V.M.); (A.N.)
| | - Dieter Manstein
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (M.W.-E.); (D.M.)
| | - Elisabeth Roider
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (M.W.-E.); (D.M.)
- Department of Dermatology, University Hospital Basel, 4055 Basel, Switzerland; (A.M.); (L.V.M.); (A.N.)
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SaeidiFard N, Haeri-Mehrizi AA, Akbarzadeh Z, Janbozorgi N, Montazeri A, Yaseri M, Shab-Bidar S. Association of health literacy and nutritional literacy with sun exposure in adults using structural equation modelling. BMC Public Health 2022; 22:1162. [PMID: 35689215 PMCID: PMC9185953 DOI: 10.1186/s12889-022-13465-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/18/2022] [Indexed: 01/04/2023] Open
Abstract
Background Inadequate health and nutritional literacy is a common problem among adults, associated with poor health outcomes. Therefore, this study aimed to investigate the relationship between health literacy and nutritional literacy to sun exposure behaviour. Methods We conducted a cross-sectional study on 261 adults (18–65 years) in Iran. Data was collected on knowledge, motivation, health literacy, nutritional literacy, and sun exposure behaviour using an interview-assisted questionnaire. Using the information–motivation–behavioural skills model and structural equation modeling, we tested whether health and nutritional literacy were associated with the relationships between knowledge of vitamin D, attitudes toward sun exposure, and sun exposure behaviour. Different models using structural equation modeling were performed to analyze the data. Results The finding showed that health literacy (β = 0.29, p < 0.001) and nutritional literacy (β = 0.14, p = 0.02) was directly associated with sunlight exposure. Indirect relationships also existed between knowledge and sunlight exposure through health literacy (β = 0.33, p < 0.001) and nutritional literacy (β = 0.22, p = 0.01). The model had good fit (x2/df = 1.422; RMSEA = 0.040; CFI = 0.851; NFI = 0.657). There was no significant relationship between health literacy and motivation (β = 0.11, p = 0.16), nutritional literacy and motivation (β = 0.06, p = 0.42) and motivation and sun exposure (β = 0.01, p = 0.91). Conclusions The findings showed that individuals with sufficient health literacy and nutritional literacy were more likely to have exposure to sunlight. Health and nutritional literacy should be considered when educating adults about vitamin D supplements and sunlight exposure.
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Affiliation(s)
- Nasim SaeidiFard
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran
| | - Ali Asghar Haeri-Mehrizi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Zahra Akbarzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran
| | - Nasim Janbozorgi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.,Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran.
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Karlsson E, Hübner IM, Haluza D, Falk M. Validation of SEPI in German-A German Translation of the Sun Exposure and Protection Index. Int J Environ Res Public Health 2020; 17:ijerph17176172. [PMID: 32854416 PMCID: PMC7504206 DOI: 10.3390/ijerph17176172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test–retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbach’s alpha, for the baseline responses was 0.70 (95% C.I: 0.63–0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66–0.78) for part 2 (propensity to increase sun protection). Test–retest stability was high, with weighted Kappa >0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns.
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Affiliation(s)
- Elias Karlsson
- Department of Medicine, Health and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden; (E.K.); (M.F.)
| | - Inga-Marie Hübner
- Association of Dermatological Prevention [ADP], 20457 Hamburg, Germany
- Correspondence:
| | - Daniela Haluza
- Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Magnus Falk
- Department of Medicine, Health and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden; (E.K.); (M.F.)
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Geoffrey K, Mwangi AN, Maru SM. Sunscreen products: Rationale for use, formulation development and regulatory considerations. Saudi Pharm J 2019; 27:1009-1018. [PMID: 31997908 PMCID: PMC6978633 DOI: 10.1016/j.jsps.2019.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/13/2019] [Indexed: 12/03/2022] Open
Abstract
The association of sunrays with skin damage have been known since medieval times. The description of the electromagnetic spectrum facilitated the identification of the ultraviolet light spectrum as being responsible for skin damage resulting from prolonged skin exposure. Sunscreens have been used since ancient civilizations with various measures to limit exposure to sun exposure being employed. Awareness of the risks associated with sunrays has been increasing in the last century, and as a result, the science, technologies, and formulation have advanced significantly. The use of sunscreen products continues rising as government health agencies seek to contain increasing cases of UV induced melanomas. Recreational sunbathing and artificial tanning have increased the risk for these diseases significantly. This review article sought to expound the scientific basis of sunscreen use, the classification, formulation, quality control and regulation across the different countries around the world. The literature review was conducted on Google scholar, PubMed, SCOPUS, Cochrane, BMJ, SCIELO among others.
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Affiliation(s)
- Kiriiri Geoffrey
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya
| | - A N Mwangi
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya
| | - S M Maru
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya
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Abstract
Recently in Canada, there has been an effort to create consistent messaging about sun safety as there is a lack of up-to-date evidence-based guidelines regarding sun-protection measures. This review aimed to provide updated, evidence-based recommendations on sunscreen application, safety, and sun protection regarding the following topics for which there is clinical uncertainty: physical barriers, sunscreen properties, sunscreen application, and risk-benefit analysis.
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Affiliation(s)
- Heidi Li
- University of Ottawa, ON, Canada
| | - Sophia Colantonio
- University of Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, ON, Canada
| | - Andrea Dawson
- University of Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, ON, Canada
| | - Xing Lin
- University of Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, ON, Canada
| | - Jennifer Beecker
- University of Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, ON, Canada
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Bertozzi N, Simonacci F, Greco MP, Grignaffini E, Raposio E. Single center evidence for the treatment of basal cell carcinoma of the head and neck. Acta Biomed 2019; 90:77-82. [PMID: 30889158 PMCID: PMC6502149 DOI: 10.23750/abm.v90i1.6395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 01/15/2023]
Abstract
AIM Basal Cell Carcinoma (BCC) alone accounts for 80% of cases of non-melanoma skin cancer (NMSC), which characteristically develops on sun-exposed skin. Indeed the most common site of BCC is the head and neck region (80%). The purpose of this study to review the experience of our center with BCC in the head and neck region to report the sites of occurrence and treatment. MATERIALS AND METHOD We retrospectively reviewed 77 patients with BCC of the head and neck, who revived surgical treatment within our plastic surgery division. Basic demographic data, cancer site and size, surgical treatment and histological data were collected. The mean follow-up period was 12 months. RESULTS The study population included 37 males and 40 females, with a mean age of 74.12 years. The nasal unit was the main site of BCC (31.82%), followed by the periorbital (13.64%) and cervical (12.5%) units. Primary closure was the main surgical procedure performed (72.5%), followed by local flap (26.1%) and full-thickness skin grafts (1.4%). The safety resection margin ranged from 4.5 to 9 mm, with a 98.7% complete removal rate. Neither recurrence nor any newly-developed lesions were reported during follow-up in any patient. DISCUSSION Our work reflects the shift in the incidence of BCC, which now seems to be more frequent in females. Furthermore, our data strengthens the association between UVR exposure and BCC, confirms its predilection to occur on the nasal unit and validates surgical excision as the gold standard treatment for skin cancer.
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Affiliation(s)
- Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy..
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Foo S, Nightingale P, Gazzani P, Bader E, Ogboli M, Martin-Clavijo A, Milford D, Kelly D, Moss C, Thomson M. A 10-year longitudinal follow-up study of a U.K. paediatric transplant population to assess for skin cancer. Br J Dermatol 2018; 179:1368-1375. [PMID: 29701240 DOI: 10.1111/bjd.16697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 01/25/2023]
Affiliation(s)
- S.H. Foo
- Sandwell and West Birmingham Hospitals NHS Trust; Department of Dermatology; Birmingham U.K
| | - P.G. Nightingale
- University Hospital Birmingham NHS Foundation Trust; Department of Dermatology; Birmingham U.K
| | - P. Gazzani
- University Hospital Birmingham NHS Foundation Trust; Department of Dermatology; Birmingham U.K
| | - E. Bader
- University Hospital Birmingham NHS Foundation Trust; Department of Dermatology; Birmingham U.K
| | - M. Ogboli
- Department of Dermatology; Birmingham Women's and Children's NHS Foundation Trust; Birmingham U.K
| | - A. Martin-Clavijo
- University Hospital Birmingham NHS Foundation Trust; Department of Dermatology; Birmingham U.K
| | - D.V. Milford
- Department of Nephrology; Birmingham Women's and Children's NHS Foundation Trust; Birmingham U.K
| | - D.A. Kelly
- Department of Hepatology; Birmingham Women's and Children's NHS Foundation Trust; Birmingham U.K
| | - C. Moss
- Department of Dermatology; Birmingham Women's and Children's NHS Foundation Trust; Birmingham U.K
| | - M.A. Thomson
- Sandwell and West Birmingham Hospitals NHS Trust; Department of Dermatology; Birmingham U.K
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8
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Abstract
The use of sunscreens with sun protection factors beyond 50 is controversial. In order to avoid misleading the consumer, several countries have already decided not to declare SPF beyond 50 on sunscreen products. Arguments against high SPF include the following: the risk of imbalanced protection, which could increase the risk of damage caused by longer-wave ultraviolet radiation; imparting a false sense of safety, which could lead to the extension of sun exposure times; health risks from higher concentrations of filter substances; and the only marginally higher blockade provided by high SPF sunscreens. On the other hand, it has been realized that the functional SPF of sunscreens remains far behind the declared SPF in the practical application and, therefore, the use of higher SPF in sensitive individuals and during strong UV exposure could make sense.
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Affiliation(s)
- T Herzinger
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, 80337, München, Deutschland.
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Olsen C, Wilson L, Green A, Biswas N, Loyalka J, Whiteman D. How many melanomas might be prevented if more people applied sunscreen regularly? Br J Dermatol 2017; 178:140-147. [DOI: 10.1111/bjd.16079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 01/09/2023]
Affiliation(s)
- C.M. Olsen
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
- The University of Queensland School of Public Health Herston Queensland 4006 Australia
| | - L.F. Wilson
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
| | - A.C. Green
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
- The University of Queensland School of Public Health Herston Queensland 4006 Australia
- Cancer Research U.K. Manchester Institute and University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - N. Biswas
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
| | - J. Loyalka
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
| | - D.C. Whiteman
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
- The University of Queensland School of Public Health Herston Queensland 4006 Australia
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Khalid AT, Moore CG, Hall C, Olabopo F, Rozario NL, Holick MF, Greenspan SL, Rajakumar K. Utility of sun-reactive skin typing and melanin index for discerning vitamin D deficiency. Pediatr Res 2017; 82:444-51. [PMID: 28467404 DOI: 10.1038/pr.2017.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/19/2017] [Indexed: 12/15/2022]
Abstract
BackgroundSkin color, a vitamin D status determinant, can be assessed subjectively by Fitzpatrick sun-reactive skin typing (FST) and objectively by melanin index (MI). FST was validated against MI for discerning vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) <20 ng/ml) in children.MethodsWe measured FST, MI, and serum 25(OH)D in healthy, 8- to 18-year-old children from one of two vitamin D trials. MI from forehead, hand, and upper arm split at the median of the more racially balanced study cohort and FST (I-III vs. IV-V) were used for discriminating vitamin D deficiency.ResultsA total of 296 participants (mean age, 12.3±2.3 years; black, 208; FST IV-V, 209; 25(OH)D <20 ng/ml, 159) were studied. MI and FST had a strong positive association. Serum 25(OH)D was negatively associated with MI and FST. Sensitivity, specificity, and predictive values were similar for discriminating vitamin D deficiency between higher vs. lower MI and between FST I-III vs. IV-V. ROC area under the curves for FST (0.59) and MI (forehead (0.63); hand (0.62); and arm (0.64)) were similar.ConclusionsFST is comparable to MI for discerning vitamin D deficiency and can be deemed as an inexpensive, useful surrogate measure of skin color in the context of vitamin D research.
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Cardoso FADMES, Mesquita GV, Campelo V, Martins MDCDCE, Almeida CAPL, Rabelo RS, Rocha AEA, Santos JLOD. Prevalence of photoprotection and its associated factors in risk group for skin cancer in Teresina, Piauí. An Bras Dermatol 2017; 92:206-210. [PMID: 28538880 PMCID: PMC5429106 DOI: 10.1590/abd1806-4841.20174831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background: The incidence of skin cancer has increased worldwide, particularly melanoma rates, which had a mean development of 2.6 % a year in the last 10 years. The agreement on the relation between long-term or chronic exposure to the sun and the emergence of these neoplasias has made several workers who perform activities exposed to solar radiation to form a risk group for the development of skin cancer, community health agents included. OBJECTIVES: To analyze the prevalence of sunscreen-use-related factors to skin cancer in a labor risk group. METHODOLOGY: Cross-sectional study with community health agents selected through simple random sampling. After collecting data using semi-structured interviews, a descriptive analysis was performed for the qualitative variables, bivariate analysis was employed for checking the association between sunscreen use and sociodemographic, occupational and knowledge about skin variables, and multivariate analysis was conducted to check independent variables associated to sunscreen use. A 5% significance level was used. Results: Of 261 health gents selected, 243 were able to participate in the study. The prevalence rate of sunscreen use was 34.2% (95% CI: 28.2-40.2). Factors associated with sunscreen use were female sex, advanced age, use of sunscreen in situations when the skin got burnt, knowledge of the negative effects of the sun on the skin and skin cancer history. Conclusions: The prevalence found reveals that there is a need for implementing educational strategies in health services regarding photoprotection.
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Affiliation(s)
| | - Gerardo Vasconcelos Mesquita
- Centro Universitário Uninovafapi - Teresina (PI), Brazil.,Universidade Federal do Piauí (Ufpi) - Teresina (PI), Brazil
| | - Viriato Campelo
- Universidade Federal do Piauí (Ufpi) - Teresina (PI), Brazil.,Universidade Estadual de Campinas (Unicamp) - Campinas (SP), Brazil
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Abstract
BACKGROUND The elevated rates of ultraviolet radiation (UVR) exposure and low rates of sun protection in young adult women indicate a need for age- and gender-appropriate interventions that address these behaviors. AIMS To examine the effects of daily behavior tracking and individually tailored text messages on sun protection and UVR exposure behaviors in young adult women at moderate to high risk of developing skin cancer. METHOD One hundred and four young adult women at risk of skin cancer were randomized to receive the behavior-tracking intervention only, tailored text messages only, both interventions, or neither. Outcomes were self-reported UVR exposure and sun protection behaviors. RESULTS Those who received the behavior-tracking intervention reported significantly fewer UVR exposure behaviors at 4-week follow-up, relative to those who did not receive behavior tracking. At 4-week follow-up, those who received daily tailored text messages reported significantly greater UVR exposure behaviors but were more likely to report wearing a hat as a form of sun protection, relative to those who did not receive tailored messages. DISCUSSION Daily behavior tracking may be repetitive, but repetition may facilitate cognitive processing and the development of healthy habits. Health messages that are less interactive, on the other hand, need to be adequately tailored and delivered with the most advantageous timing to be impactful. CONCLUSION Future research should continue to examine how these interventions differentially affect behavior and how they can be adapted to apply to other health behaviors.
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Affiliation(s)
- Susan Darlow
- 1 National Comprehensive Cancer Network, Washington, PA, USA
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de Blacam C, Dermott CM, Sugrue C, Kilmartin D, Kelly J. Patient awareness and sun protection behaviour following excision of basal cell carcinoma. Surgeon 2017; 15:12-7. [DOI: 10.1016/j.surge.2015.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 07/08/2015] [Indexed: 11/22/2022]
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14
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Vilela FM, Oliveira FM, Vicentini FT, Casagrande R, Verri WA, Cunha TM, Fonseca MJ. Commercial sunscreen formulations: UVB irradiation stability and effect on UVB irradiation-induced skin oxidative stress and inflammation. Journal of Photochemistry and Photobiology B: Biology 2016; 163:413-20. [DOI: 10.1016/j.jphotobiol.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/01/2016] [Accepted: 09/03/2016] [Indexed: 12/20/2022]
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Sánchez G, Nova J, Rodriguez‐Hernandez AE, Medina RD, Solorzano‐Restrepo C, Gonzalez J, Olmos M, Godfrey K, Arevalo‐Rodriguez I. Sun protection for preventing basal cell and squamous cell skin cancers. Cochrane Database Syst Rev 2016; 7:CD011161. [PMID: 27455163 PMCID: PMC6457780 DOI: 10.1002/14651858.cd011161.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND 'Keratinocyte cancer' is now the preferred term for the most commonly identified skin cancers basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), which were previously commonly categorised as non-melanoma skin cancers (NMSC). Keratinocyte cancer (KC) represents about 95% of malignant skin tumours. Lifestyle changes have led to increased exposure to the sun, which has, in turn, led to a significant increase of new cases of KC, with a worldwide annual incidence of between 3% and 8%. The successful use of preventive measures could mean a significant reduction in the resources used by health systems, compared with the high cost of the treatment of these conditions. At present, there is no information about the quality of the evidence for the use of these sun protection strategies with an assessment of their benefits and risks. OBJECTIVES To assess the effects of sun protection strategies (i.e. sunscreen and barrier methods) for preventing keratinocyte cancer (that is, basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) of the skin) in the general population. SEARCH METHODS We searched the following databases up to May 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trial registries and the bibliographies of included studies for further references to relevant trials. SELECTION CRITERIA We included randomised controlled clinical trials (RCTs) of preventive strategies for keratinocyte cancer, such as physical barriers and sunscreens, in the general population (children and adults), which may provide information about benefits and adverse events related to the use of solar protection measures. We did not include trials focused on educational strategies to prevent KC or preventive strategies in high-risk groups. Our prespecified primary outcomes were BCC or cSCC confirmed clinically or by histopathology at any follow-up and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for eligibility using Early Review Organizing Software (EROS). Similarly, two review authors independently used predesigned data collection forms to extract information from the original study reports about the participants, methods of randomisation, blinding, comparisons of interest, number of participants originally randomised by arm, follow-up losses, and outcomes, and they assessed the risk of bias. We resolved any disagreement by consulting a third author and contacted trial investigators of identified trials to obtain additional information. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included one RCT (factorial design) that randomised 1621 participants.This study compared the daily application of sunscreen compared with discretionary use of sunscreen, with or without beta-carotene administration, in the general population. The study was undertaken in Australia; 55.2% of participants had fair skin, and they were monitored for 4.5 years for new cases of BCC or cSCC assessed by histopathology. We found this study to be at low risk of bias for domains such as allocation, blinding, and incomplete outcome data. However, we found multiple unclear risks related to other biases, including an unclear assessment of possible interactions between the effects of the different interventions evaluated (that is, sunscreen and beta-carotene). We found no difference in terms of the number of participants developing BCC (n = 1621; risk ratio (RR) 1.03, 95% confidence interval (CI) 0.74 to 1.43) or cSCC (n = 1621; RR 0.88, 95% CI 0.50 to 1.54) when comparing daily application of sunscreen with discretionary use, even when analyses were restricted to groups without beta-carotene supplementation. This evidence was of low quality, which means that there is some certainty that future studies may alter our confidence in this evidence.We reported adverse events in a narrative way and included skin irritation or contact allergy.We identified no studies that evaluated other sun protection measures, such as the use of sun-protective clothing, sunglasses, or hats, or seeking the shade when outdoors. AUTHORS' CONCLUSIONS In this review, we assessed the effect of solar protection in preventing the occurrence of new cases of keratinocyte cancer. We only found one study that was suitable for inclusion. This was a study of sunscreens, so we were unable to assess any other forms of sun protection. The study addressed our prespecified primary outcomes, but not most of our secondary outcomes. We were unable to demonstrate from the available evidence whether sunscreen was effective for the prevention of basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC).Our certainty in the evidence was low because there was a lack of histopathological confirmation of BCC or cSCC in a significant percentage of cases. Amongst other sources of bias, it was not clear whether the study authors had assessed any interaction effects between the sunscreen and beta-carotene interventions. We think that further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
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Affiliation(s)
- Guillermo Sánchez
- Instituto de Evaluación Tecnológica en SaludBogotá D.C.Colombia
- Fundación Universitaria de Ciencias de la SaludDivision of ResearchBogotá D.C.Colombia
| | - John Nova
- Instituto Nacional de Dermatología, Centro Dermatológico Federico Lleras AcostaAvenida 1a N°. 13 A 61Bogotá D.C.Colombia11001000
| | | | - Roger David Medina
- Fundación Universitaria de Ciencias de la SaludDivision of ResearchBogotá D.C.Colombia
| | - Carolina Solorzano‐Restrepo
- Fundación Universitaria de Ciencias de la SaludDepartment of DermatologyCarrera 18 # 8‐95Bogotá D.C.Colombia11001000
| | - Jenny Gonzalez
- Fundación Universitaria de Ciencias de la SaludDepartment of DermatologyCarrera 18 # 8‐95Bogotá D.C.Colombia11001000
| | - Miguel Olmos
- Fundación Universitaria de Ciencias de la SaludDepartment of DermatologyCarrera 18 # 8‐95Bogotá D.C.Colombia11001000
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Ingrid Arevalo‐Rodriguez
- Instituto de Evaluación Tecnológica en SaludBogotá D.C.Colombia
- Fundación Universitaria de Ciencias de la SaludDivision of ResearchBogotá D.C.Colombia
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Abstract
The epidemiology of melanoma is complex, and individual risk depends on sun exposure, host factors, and genetic factors, and in their interactions as well. Sun exposure can be classified as intermittent, chronic, or cumulative (overall) exposure, and each appears to have a different effect on type of melanoma. Other environmental factors, such as chemical exposures-either through occupation, atmosphere, or food-may increase risk for melanoma, and this area warrants further study. Host factors that are well known to be important are the numbers and types of nevi and the skin phenotype. Genetic factors are classified as high-penetrant genes, moderate-risk genes, or low-risk genetic polymorphisms. Subtypes of tumors, such as BRAF-mutated tumors, have different risk factors as well as different therapies. Prevention of melanoma has been attempted using various strategies in specific subpopulations, but to date optimal interventions to reduce incidence have not emerged.
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Affiliation(s)
- Marianne Berwick
- Department of Internal Medicine, University of New Mexico, MSC10-5550, Albuquerque, NM, 87131-0001, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO, 80401, USA.
| | - Anne Cust
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Richard Gallagher
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Tim K Lee
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Frank Meyskens
- Public Health and Epidemiology, University of California, Irvine, USA.
| | - Shaily Pandey
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nancy E Thomas
- University of North Carolina, 413 Mary Ellen Jones Bldg. CB#7287, Chapel Hill, NC, 275992, USA.
| | - Marit B Veierød
- Department of Biostatistics, Institute of Basic Medical Sciences, P.O. Box 1122 Blindern, 0317, Oslo, Norway.
| | - Sarah Ward
- Centre for Genetic Origins of Health and Disease (GOHaD), The University of Western Australia, M409, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
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17
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Nahar VK, Allison Ford M, Brodell RT, Boyas JF, Jacks SK, Biviji-Sharma R, Haskins MA, Bass MA. Skin cancer prevention practices among malignant melanoma survivors: a systematic review. J Cancer Res Clin Oncol 2015; 142:1273-83. [PMID: 26642962 DOI: 10.1007/s00432-015-2086-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 11/21/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE This systematic review was conducted to evaluate and summarize the existing literature on prevalence of ultraviolet radiation (UVR) exposure, sun protection, and screening behaviors among individuals diagnosed with malignant melanoma (MM). METHODS The search was performed in PubMed, CINAHL, PsycINFO, ScienceDirect, EMBASE, and ERIC from inception of each database through July 2014. Studies were included if (1) individuals diagnosed with MM were the primary sample, (2) measured UVR exposure, primary and secondary preventive behaviors, (3) original research communication that constitutes an entire set of empirical data, (4) observational design, and (5) English peer-reviewed. Studies were excluded if (1) all of the inclusion criteria were not met and (2) duplicates, conference abstracts, editorials, news, letters to the editor, comments, reviews, feature articles, white papers, and guidelines. RESULTS The search resulted in 255 articles that were screened for relevance; however, only 15 articles met all of the inclusion criteria. Most of the studies were cross-sectional (n = 10), used self-administered surveys (n = 8), and were conducted in North America (n = 10). The sample sizes ranged considerably, but were mostly Caucasian (n = 6) and included a higher proportion of women (n = 8). Evidence demonstrated that individuals with MM still engaged in sunbathing, indoor tanning, and reported sunburns. Moreover, survivors reported inadequate levels of both sun protection and skin self-examinations. CONCLUSIONS The findings highlight the need for intensifying intervention strategies to reduce the risk of new primary MMs in this group. Future research should increase in rigor and include more diverse populations and regions.
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Affiliation(s)
- Vinayak K Nahar
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA. .,Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.
| | - M Allison Ford
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
| | - Robert T Brodell
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.,Department of Pathology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.,Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Javier F Boyas
- Department of Social Work, University of Mississippi, 208 Longstreet Hall, PO Box 1848, Oxford, MS, 38677, USA
| | - Stephanie K Jacks
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA
| | - Rizwana Biviji-Sharma
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, IUPUI, 714 N. Senate Ave, Suite 250, Indianapolis, IN, 46202, USA
| | - Mary A Haskins
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
| | - Martha A Bass
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
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18
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Antonov D, Hollunder M, Schliemann S, Elsner P. Ultraviolet Exposure and Protection Behavior in the General Population: A Structured Interview Survey. Dermatology 2015; 232:11-6. [DOI: 10.1159/000440698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/28/2015] [Indexed: 11/19/2022] Open
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19
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Detert H, Hedlund S, Anderson CD, Rodvall Y, Festin K, Whiteman DC, Falk M. Validation of sun exposure and protection index (SEPI) for estimation of sun habits. Cancer Epidemiol 2015; 39:986-93. [PMID: 26547793 DOI: 10.1016/j.canep.2015.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND In both Sweden and Australia high incidence rates of skin cancer have become a major health problem. In prevention and risk communication, it is important to have reliable ways for identifying people with risky sun habits. In this study the validity and reliability of the questionnaire Sun Exposure Protection Index (SEPI), developed to assess individual's sun habits and their propensity to increase sun protection during routine, often brief, clinical encounters, has been evaluated. The aim of our study was to evaluate validity and reliability of the proposed SEPI scoring instrument, in two countries with markedly different ultraviolet radiation environments (Sweden and Australia). METHOD Two subpopulations in Sweden and Australia respectively were asked to fill out the SEPI together with the previously evaluated Readiness to Alter Sun Protective Behaviour questionnaire (RASP-B) and the associated Sun-protective Behaviours Questionnaire. To test reliability, the SEPI was again filled out by the subjects one month later. RESULTS Comparison between SEPI and the questions in the Sun-protective Behaviours Questionnaire, analyzed with Spearman's Rho, showed good correlations regarding sun habits. Comparison between SEPI and RASP-B regarding propensity to increase sun protection showed concurrently lower SEPI mean scores for action stage, but no difference between precontemplation and contemplation stages. The SEPI test-retest analysis indicated stability over time. Internal consistency of the SEPI, assessed with Cronbach's alpha estimation showed values marginally lower than the desired >0.70 coefficient value generally recommended, and was somewhat negatively affected by the question on sunscreen use, likely related to the classic "sunscreen paradox". There were some differences in the performance of the SEPI between the Swedish and Australian samples, possibly due to the influence of "available" sunlight and differing attitudes to behaviour and protection "at home" and on vacation. CONCLUSIONS SEPI appears to be a stable instrument with an overall acceptable validity and reliability, applicable for use in populations exposed to different UVR environments, in order to evaluate individual sun exposure and protection.
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Affiliation(s)
- H Detert
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - S Hedlund
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - C D Anderson
- Division of Dermatology, Department of Clinical and Experimental Medicine, Linköping University, S-581 83 Linköping, Sweden.
| | - Y Rodvall
- Department of Public Health Sciences, Karolinska Institutet, S-171 77 Stockholm, Sweden.
| | - K Festin
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - D C Whiteman
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Qld 4029 Herston, Australia.
| | - M Falk
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
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20
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Mandal S, Bera R, Das S, Nayak SK, Pramanik A, Patra A. Photon Harvesting in Sunscreen-Based Functional Nanoparticles. Chemphyschem 2015; 16:3618-24. [PMID: 26419334 DOI: 10.1002/cphc.201500780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Indexed: 11/12/2022]
Abstract
The ultraviolet light component in the solar spectrum is known to cause several harmful effects, such as allergy, skin ageing, and skin cancer. Thus, current research attention has been paid to the design and fundamental understanding of sunscreen-based materials. One of the most abundantly used sunscreen molecules is Avobenzone (AB), which exhibits two tautomers. Here, we highlight the preparation of spherically shaped nanoparticles from the sunscreen molecule AB as well as from sunscreen-molecule-encapsulated polymer nanoparticles in aqueous media and study their fundamental photophysical properties by steady-state and time-resolved spectroscopy. Steady-state studies confirm that the AB molecule is in the keto and enol forms in tetrahydrofuran, whereas the enol form is stable in the case of both AB nanoparticles and AB-encapsulated poly(methyl methacrylate) (PMMA) nanoparticles. Thus, the keto-enol transformation of AB molecules is restricted to a nanoenvironment. An enhancement of photostability in both the nanoparticle and PMMA-encapsulated forms under UV light irradiation is observed. The efficient excited energy transfer (60 %) from AB to porphyrin molecules opens up further prospects in potential applications as light-harvesting systems.
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Affiliation(s)
- Sadananda Mandal
- Department of Materials Science, Indian Association for the Cultivation of Science, Kolkata, 700 032, India.,Department of Chemistry, Vivekananda Mahavidyalaya, Burdwan, Sripally, Burdwan-, 713103, West Bengal, India
| | - Rajesh Bera
- Department of Materials Science, Indian Association for the Cultivation of Science, Kolkata, 700 032, India
| | - Somnath Das
- Unilever R & D Bangalore, 64, Main Road, Whitefield, Bangalore, 560066, India
| | - Sandip K Nayak
- Bio-organic Division, Bhabha Atomic Research Centre, Mumbai-, 400 085, India
| | - Amitava Pramanik
- Unilever R & D Bangalore, 64, Main Road, Whitefield, Bangalore, 560066, India.
| | - Amitava Patra
- Department of Materials Science, Indian Association for the Cultivation of Science, Kolkata, 700 032, India.
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21
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Tyagi N, Bhardwaj A, Srivastava SK, Arora S, Marimuthu S, Deshmukh SK, Singh AP, Carter JE, Singh S. Development and Characterization of a Novel in vitro Progression Model for UVB-Induced Skin Carcinogenesis. Sci Rep 2015; 5:13894. [PMID: 26349906 DOI: 10.1038/srep13894] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/07/2015] [Indexed: 12/13/2022] Open
Abstract
Epidemiological studies suggest ultraviolet B (UVB) component (290–320 nm) of sun light is the most prevalent etiologic factor for skin carcinogenesis- a disease accounting for more than two million new cases each year in the USA alone. Development of UVB-induced skin carcinoma is a multistep and complex process. The molecular events that occur during UVB-induced skin carcinogenesis are poorly understood largely due to the lack of an appropriate cellular model system. Therefore, to make a progress in this area, we have developed an in vitro model for UVB-induced skin cancer using immortalized human epidermal keratinocyte (HaCaT) cells through repetitive exposure to UVB radiation. We demonstrate that UVB-transformed HaCaT cells gain enhanced proliferation rate, apoptosis-resistance, and colony- and sphere-forming abilities in a progressive manner. Moreover, these cells exhibit increased aggressiveness with enhanced migration and invasive potential and mesenchymal phenotypes. Furthermore, these derived cells are able to form aggressive squamous cell carcinoma upon inoculation into the nude mice, while parental HaCaT cells remain non-tumorigenic. Together, these novel, UVB-transformed progression model cell lines can be very helpful in gaining valuable mechanistic insight into UVB-induced skin carcinogenesis, identification of novel molecular targets of diagnostic and therapeutic significance, and in vitro screening for novel preventive and therapeutic agents.
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22
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Barber K, Searles GE, Vender R, Teoh H, Ashkenas J. Non-melanoma Skin Cancer in Canada Chapter 2: Primary Prevention of Non-melanoma Skin Cancer. J Cutan Med Surg 2015; 19:216-26. [PMID: 25775622 DOI: 10.1177/1203475415576465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC), including basal and squamous cell carcinoma (BCC and SCC), represents the most common malignancy. OBJECTIVE To provide guidance to Canadian health care practitioners regarding primary prevention of NMSC. METHODS Structured literature searches were conducted, using search terms including prevention, sunscreen, and sun prevention factor. All recommendations concern guidance that physicians should regularly discuss with their patients to help establish photoprotection habits. The GRADE system was used to assign strength to each recommendation. RESULTS Ultraviolet exposure is the major modifiable risk factor for NMSC. Aspects of photoprotection, including effective sunscreen use and avoidance of both the midday sun and artificial tanning, are discussed. Several widespread misunderstandings that undermine responsible public health measures related to sun safety are addressed. CONCLUSIONS Photoprotection represents both an individual priority and a public health imperative. By providing accurate information during routine patient visits, physicians reinforce the need for ongoing skin cancer prevention.
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Affiliation(s)
- Kirk Barber
- Kirk Barber Research, Calgary, AB, Canada University of Calgary, Calgary, AB, Canada
| | | | - Ronald Vender
- Dermatrials Research, Hamilton, ON, Canada McMaster University, Hamilton, ON, Canada
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23
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Abstract
Ultraviolet radiation plays a major role in the development of nonmelanoma and melanoma skin cancers. Photoprotection by sunscreens has been shown to prevent the development of actinic keratosis, squamous cell carcinoma, melanoma, and photoaging. However, these benefits are only derived if the users apply sunscreen appropriately and practice other sun protection measures. This review discusses the health benefits provided by sunscreen use, updates the latest regulatory landscape on sunscreen, and addresses the controversies and limitations associated with sunscreen use.
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Affiliation(s)
- Silvia E Mancebo
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA
| | - Judy Y Hu
- Global Health Research LLC, Chatham, NJ, USA
| | - Steven Q Wang
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA.
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24
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Heurung AR, Raju SI, Warshaw EM. Adverse Reactions to Sunscreen Agents: Epidemiology, Responsible Irritants and Allergens, Clinical Characteristics, and Management. Dermatitis 2014; 25:289-326. [DOI: 10.1097/der.0000000000000079] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Abstract
PURPOSE OF REVIEW Cosmeceuticals are substances that exert physiologic changes to the skin for aesthetic purposes and are popular alternatives to invasive cosmetic procedures for antiaging. Cosmeceuticals are being used on children; yet studies of cosmeceuticals in the pediatric population are limited. RECENT FINDINGS Cosmeceuticals remain an unrecognized category by the US Food and Drug Administration, and therefore stringent regulatory pathways do not exist to guide research and marketing. To date, no safety and efficacy study exists on cosmeceutical use in pediatric patients. Increasing knowledge of the mechanisms underlying intrinsic and extrinsic skin aging, including reactive oxygen species formation, effects of declining hormones, and ultraviolet radiation, forms the scientific basis for common cosmeceuticals such as retinoids, botanicals such as soy isoflavones, and even moisturizers and sunscreen. Virtually all studies on cosmeceuticals have been performed in women with varying degrees of skin aging. The cosmeceuticals most likely to be used by younger children are moisturizers and sunscreens. As the popularity and availability of other antiaging cosmeceuticals grow, practitioners will encounter more and more beauty-conscious teenagers using these products for preventive rather than restorative purposes. SUMMARY Pediatricians should be familiar with the use of common cosmeceuticals used in children, especially the use of broad-spectrum sunscreen. In the future, more children will be exposed to cosmeceuticals and may experience side effects such as contact dermatitis and skin irritation.
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Suppa M, Neri L, Bianchi L, Capizzi R, Carbone A, Catricalà C, Chimenti S, Fargnoli MC, Fossati B, Frascione P, Peris K. The first skin cancer screening day at the Italian parliament: a Euromelanoma initiative. Int J Dermatol 2014; 54:42-9. [PMID: 25070362 DOI: 10.1111/ijd.12677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effort to decrease incidence/mortality of skin cancer should target not only the general public but also politicians and decision makers, to create a proper health policy. We report the results of the first Skin Cancer Screening Day at the Italian Parliament, organized to draw politicians' attention on skin cancer. METHODS A questionnaire was used to collect data on participants' characteristics and suspected skin cancers. RESULTS We screened 70 members of parliament (61.4% males, median age 54 years). Overall skin cancer suspicion rate was 14.5%. Suspicion rate, detection rate, and positive predictive values for melanoma were respectively 1.6, 1.6, and 100%, and for basal cell carcinoma 6.5, 1.6, and 25%. Highly educated, <54-year-old females reported sun-seeking behaviors. CONCLUSIONS The considerable suspicion rate produced by this screening is justified by the particular demographics of the study population. Italian members of parliament display sun-seeking behaviors similar to those previously described in the general public. Increasing politicians' attention on skin cancer is vital for sufficient resources to be allocated to prevention strategies. Expert medical groups and politicians should cooperate to create a proper, integrated policy on skin cancer.
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Affiliation(s)
- Mariano Suppa
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy; Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Etzkorn JR, Parikh RP, Marzban SS, Law K, Davis AH, Rawal B, Schell MJ, Sondak VK, Messina JL, Rendina LE, Zager JS, Lien MH. Identifying risk factors using a skin cancer screening program. Cancer Control 2014; 20:248-54. [PMID: 24077401 DOI: 10.1177/107327481302000402] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The incidence of melanoma and nonmelanoma skin cancer continues to increase. To detect lesions at an earlier phase in their progression, skin cancer screening programs have been advocated by some. However, the effectiveness of skin cancer screening and the ideal population that these screenings should target have yet to be firmly established. This study details the relationship of a group of well-known risk factors with presumptive diagnoses in a large series of individuals self-referred for free skin cancer screening. METHODS Data obtained during 2007 to 2010 from a descriptive cross-sectional study skin cancer screening program are presented. Participant history was recorded using standardized medical history forms prior to skin examination. Screeners conducted a skin examination varying from whole-body to limited areas (per participant preference) and recorded diagnoses. Diagnoses were assigned to the nonmelanoma cancer (NMC) or suspicious pigmented lesion group for analysis. RESULTS A presumptive diagnosis of NMC was associated with male sex, age ≥ 50 years, personal history of skin cancer, lower skin phototype, increased sunscreen use, and increased chronic sun exposure (all P values ≤ .0001). After controlling for skin phototype, increased sunscreen use was not associated with a presumptive diagnosis of NMC (P = .96). Presumptive diagnosis of a suspicious pigmented lesion was associated with a reported history of "changing mole" (P < .0001) and negatively associated with age ≥ 50 years (P < .0001) and a personal history of skin cancer (P = .0119). CONCLUSIONS Several known risk factors for nonmelanoma skin cancer correlated with a presumptive diagnosis of NMC. The yield of presumptive atypical pigmented lesions was increased in participants aged < 50 years, supporting the notion that this population may benefit from screening.
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Affiliation(s)
- Jeremy R Etzkorn
- University of South Florida, College of Medicine, Department of Dermatology and Cutaneous Surgery, Tampa, FL 33612, USA.
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Sattler U, Thellier S, Sibaud V, Taïeb C, Mery S, Paul C, Meyer N. Factors associated with sun protection compliance: results from a nationwide cross-sectional evaluation of 2215 patients from a dermatological consultation. Br J Dermatol 2014; 170:1327-35. [DOI: 10.1111/bjd.12966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- U. Sattler
- Laboratoires Dermatologiques Avène; Pierre Fabre Dermo-Cosmétique; Lavaur France
| | - S. Thellier
- Department of Dermatology; Paul Sabatier University and Larrey Hospital; Toulouse France
| | - V. Sibaud
- Laboratoires Dermatologiques Avène; Pierre Fabre Dermo-Cosmétique; Lavaur France
| | - C. Taïeb
- Public Health and Quality of Life; Pierre Fabre SA; Paris France
| | - S. Mery
- Laboratoires Dermatologiques Avène; Pierre Fabre Dermo-Cosmétique; Lavaur France
| | - C. Paul
- Department of Dermatology; Paul Sabatier University and Larrey Hospital; Toulouse France
| | - N. Meyer
- Department of Dermatology; Paul Sabatier University and Larrey Hospital; Toulouse France
- Inserm UMR 1037-CRCT ‘Rho GTPases and Cancer’; Toulouse France
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Herman KN, Toffton S, McCulloch SD. Detrimental effects of UV-B radiation in a xeroderma pigmentosum-variant cell line. Environ Mol Mutagen 2014; 55:375-384. [PMID: 24549972 PMCID: PMC4102177 DOI: 10.1002/em.21857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 06/03/2023]
Abstract
DNA polymerase η (pol η), of the Y-family, is well known for its in vitro DNA lesion bypass ability. The most well-characterized lesion bypassed by this polymerase is the cyclobutane pyrimidine dimer (CPD) caused by ultraviolet (UV) light. Historically, cellular and whole-animal models for this area of research have been conducted using UV-C (λ=100-280 nm) owing to its ability to generate large quantities of CPDs and also the more structurally distorting 6-4 photoproduct. Although UV-C is useful as a laboratory tool, exposure to these wavelengths is generally very low owing to being filtered by stratospheric ozone. We are interested in the more environmentally relevant wavelength range of UV-B (λ=280-315 nm) for its role in causing cytotoxicity and mutagenesis. We evaluated these endpoints in both a normal human fibroblast control line and a Xeroderma pigmentosum variant cell line in which the POLH gene contains a truncating point mutation, leading to a nonfunctional polymerase. We demonstrate that UV-B has similar but less striking effects compared to UV-C in both its cytotoxic and its mutagenic effects. Analysis of the mutation spectra after a single dose of UV-B shows that a majority of mutations can be attributed to mutagenic bypass of dipyrimidine sequences. However, we do note additional types of mutations with UV-B that are not previously reported after UV-C exposure. We speculate that these differences are attributed to a change in the spectra of photoproduct lesions rather than other lesions caused by oxidative stress.
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Affiliation(s)
- Kimberly N. Herman
- Department of Biological Sciences, Environmental and Molecular Toxicology Program, North Carolina State University, Raleigh, North Carolina
| | - Shannon Toffton
- Department of Biological Sciences, Environmental and Molecular Toxicology Program, North Carolina State University, Raleigh, North Carolina
| | - Scott D. McCulloch
- Department of Biological Sciences, Environmental and Molecular Toxicology Program, North Carolina State University, Raleigh, North Carolina
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina
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Abstract
In the past decade, major advances have been made in the understanding of melanoma. New predisposition genes have been reported and key somatic events, such as BRAF mutation, directly translated into therapeutic management. Surgery for localised melanoma and regional lymph node metastases is the standard of care. Sentinel-node biopsy provides precise staging, but has not been reported to affect survival. The effect of lymph-node dissection on survival is a topic of investigation. Two distinct approaches have emerged to try to extend survival in patients with metastatic melanoma: immunomodulation with anti-CTLA4 monoclonal antibodies, and targeted therapy with BRAF inhibitors or MEK inhibitors for BRAF-mutated melanoma. The combination of BRAF inhibitors and MEK inhibitors might improve progression-free survival further and, possibly, increase overall survival. Response patterns differ substantially-anti-CTLA4 immunotherapy can induce long-term responses, but only in a few patients, whereas targeted drugs induce responses in most patients, but nearly all of them relapse because of pre-existing or acquired resistance. Thus, the long-term prognosis of metastatic melanoma remains poor. Anti-PD1 and anti-PDL1 antibodies have emerged as breakthrough drugs for melanoma that have high response rates and long durability. Biomarkers that have predictive value remain elusive in melanoma, although emerging data for adjuvant therapy indicate that interferon sensitivity is associated with ulceration of the primary melanoma. Intense investigation continues for clinical and biological markers that predict clinical benefit of immunotherapeutic drugs, such as interferon alfa or anti-CTLA4 antibodies, and the mechanisms that lead to resistance of targeted drugs.
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Affiliation(s)
- Alexander M M Eggermont
- Melanoma Unit and INSERM U981, Gustave Roussy Cancer Institute, Grand Paris, Villejuif, France; Erasmus University Medical Centre, Rotterdam, Netherlands.
| | - Alan Spatz
- Department of Pathology, McGill University & Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Caroline Robert
- Melanoma Unit and INSERM U981, Gustave Roussy Cancer Institute, Grand Paris, Villejuif, France
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Bjørnevik K, Riise T, Casetta I, Drulovic J, Granieri E, Holmøy T, Kampman MT, Landtblom AM, Lauer K, Lossius A, Magalhaes S, Myhr KM, Pekmezovic T, Wesnes K, Wolfson C, Pugliatti M. Sun exposure and multiple sclerosis risk in Norway and Italy: The EnvIMS study. Mult Scler 2014; 20:1042-9. [DOI: 10.1177/1352458513513968] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/31/2013] [Indexed: 11/16/2022]
Abstract
Objectives: The objective of this paper is to estimate the association between multiple sclerosis (MS) and measures of sun exposure in specific age periods in Norway and Italy. Methods: A total of 1660 MS patients and 3050 controls from Italy and Norway who participated in a multinational case-control study (EnvIMS) reported sun habits during childhood and adolescence. Results: A significant association between infrequent summer outdoor activity and increased MS risk was found in Norway and in Italy. The association was strongest between the ages of 16 and 18 years in Norway (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.30–2.59), and between birth and age 5 years in Italy (OR 1.56, 95% CI 1.16–2.10). In Italy a significant association was also found during winter (OR 1.42, 95% CI 1.03–1.97). Frequent sunscreen use between birth and the age of 6 years was associated with MS in Norway (OR 1.44, 95% CI 1.08–1.93) after adjusting for outdoor activity during the same period. Red hair (OR 1.67, 95% CI 1.06–2.63) and blonde hair (OR 1.36, 95% CI 1.09–1.70) were associated with MS after adjusting for outdoor activity and sunscreen use. Conclusion: Converging evidence from different measures underlines the beneficial effect of sun exposure on MS risk.
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Affiliation(s)
- Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Norway
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Norway
| | - Ilaria Casetta
- Department of Biomedical and Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Italy
| | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Enrico Granieri
- Department of Biomedical and Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Italy
| | - Trygve Holmøy
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Department of Neurology, Akershus University Hospital, Norway
| | - Margitta T Kampman
- Department of Clinical Neurology, University of Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Norway
| | - Anne-Marie Landtblom
- Division of Neurology, Department of Clinical and Experimental Medicine, UHL, County Council, Linköping University, Sweden
| | | | - Andreas Lossius
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Institute of Immunology, Oslo University Hospital Rikshospitalet, Norway
| | - Sandra Magalhaes
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Canada
| | - Kjell-Morten Myhr
- Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Norway
- The KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Kristin Wesnes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Norway
| | | | - Maura Pugliatti
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Clinical and Experimental Medicine, University of Sassari, Italy
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Petersen B, Wulf HC. Application of sunscreen − theory and reality. Photodermatol Photoimmunol Photomed 2014; 30:96-101. [DOI: 10.1111/phpp.12099] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Bibi Petersen
- Department of Dermatological Research; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Hans Christian Wulf
- Department of Dermatological Research; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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Abstract
Over 3 million new cases of skin cancer are diagnosed in the US annually. Melanoma, a subtype of skin cancer that can be fatal if the disease is not detected and treated at an early stage, is the most common cancer for those aged 25–29 years and the second most common cancer in adolescents and young adults aged 15–29 years. The primary carcinogen for the genesis of skin cancers is ultraviolet light from solar radiation and tanning beds. In spite of massive health campaigns to raise public awareness on ultraviolet radiation, sun-protective practices still fall behind. A plausible explanation is the lack of behavioral change in the populations at risk; in this review article, we examine sun-protective behavior in the four high-risk skin cancer groups: skin cancer survivors, individuals with a family history of melanoma, individuals with physical characteristics associated with skin cancer risk, and organ transplantation patients. Findings in the literature demonstrate that increased knowledge and awareness does not consequently translate into behavioral changes in practice. Behavior can differ as a result of different attitudes and beliefs, depending on the population at risk. Thus, intervention should be tailored to the population targeted. A multidisciplinary health team providing consultation and education is required to influence these much needed changes.
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Affiliation(s)
- Diana Y Diao
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim K Lee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada ; Cancer Control Research Program, BC Cancer Agency, Vancouver, British Columbia, Canada
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Petersen B, Thieden E, Philipsen PA, Heydenreich J, Wulf HC, Young AR. Determinants of personal ultraviolet-radiation exposure doses on a sun holiday. Br J Dermatol 2013; 168:1073-9. [PMID: 23301517 DOI: 10.1111/bjd.12211] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A great number of journeys to sunny destinations are sold to the Danish population every year. We suspect that this travel considerably increases personal annual ultraviolet-radiation (UVR) exposure doses. This is important because such exposure is the main cause of skin cancer, and studies have shown a correlation between intermittent solar UVR exposure and malignant melanoma. OBJECTIVES To prospectively monitor the behaviour of a group of sun seekers during a winter sun holiday and to study the impact of behaviour on personal UVR exposure doses. METHODS In this observational study 25 Danish sun seekers were closely monitored by on-site investigators for 6 days during a winter sun holiday in the Canary Islands, thus avoiding the possible recall bias of retrospective studies with questionnaires. The volunteers recorded their location, clothing and sunscreen use in diaries, and their UVR doses were measured by personal UVR dosimeters worn on the wrist. This resulted in 3450 half-hour registrations during 150 participation days. RESULTS On average, each volunteer received a total UVR dose of 57 standard erythema doses over 6 days, which is 43% of the annual UVR dose of a Danish indoor worker. Their exposed body area, sunscreen use and percentage of body with sunscreen application were positively correlated with their personal UVR doses, and there was also a strong relationship between location and UVR doses received. CONCLUSIONS The behaviour of the volunteers had a major impact on their personal UVR doses. Our results emphasize the importance of changing the behaviour of sun seekers with protanning attitudes to reduce their personal annual UVR exposure doses, and possibly their risk of skin cancer.
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Affiliation(s)
- B Petersen
- Department of Dermatological Research, University of Copenhagen, Bispebjerg Hospital, DK-2400, Copenhagen, Denmark.
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Abstract
We conducted a systematic review of the association between melanocytic nevi (MN) in childhood and sunscreen use. A bibliographic search was conducted between November 2008 and January 2009 using the following key words on MEDLINE and EMBASE: child*, in combination with naevi, nevi, naevus, nevus and sunscreen, sun protection. We also used Medical Subject Headings [sunscreening agents], or [radiation protection] with [nevus, pigmented]. A first screening was done on title and abstract reading. Randomized trials and cohort and cross-sectional studies analyzing the relationship between the use of sunscreen and MN in children were selected. Three reviewers abstracted data from each article. The three sets of results were compared for concordance and rereviewed if necessary. Fifteen articles were included (20,743 children). The studies were not consistent in terms of the ages of the children, MN count methods, or sunscreen use assessment. Owing to this heterogeneity, we were unable to pool the studies and conduct a meta-analysis. Twelve studies did not report that the use of sunscreen had a protective effect against MN development. Three studies reported a lower MN count when sunscreen was applied. This systematic review underlines the methodologic differences between studies. Eight of 15 studies reported a positive association between sunscreen application and MN count. Differences in MN counts, overexposure to sun, and inadequate sunscreen application on fair-skinned children could explain the disparity in the results. There is still no evidence of a protective effect of sunscreen against MN development in children.
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Affiliation(s)
- Marie-Florence de Maleissye
- Research Unit EA 4339 Skin, environment, and cancer, Ambroise Paré University Hospital, University of Versailles-Saint Quentin en Yvelines, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, Paris, France
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Suppa M, Altomare G, Cannavò SP, Capizzi R, Catricalà C, Colombo E, Fargnoli MC, Fossati B, Frascione P, Lisi P, Santini M, Scalvenzi M, Peris K. The Italian Euromelanoma Day: evaluation of results and implications for future prevention campaigns. Int J Dermatol 2012; 53:699-706. [DOI: 10.1111/j.1365-4632.2012.05783.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Mariano Suppa
- Department of Dermatology; University of L'Aquila; L'Aquila Italy
| | - Gianfranco Altomare
- Dermatological Clinic; IRCCS Galeazzi Hospital; University of Milan; Milan Italy
| | - Serafinella P. Cannavò
- Department of Territorial Social Medicine - Section of Dermatology; University of Messina; Messina Italy
| | - Rodolfo Capizzi
- Department of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - Caterina Catricalà
- Department of Oncologic Dermatology; Santa Maria and San Gallicano Institute of Dermatology - IRCCS; Rome Italy
| | - Enrico Colombo
- Dermatology Unit; University of Piemonte Orientale; Maggiore della Carità Hospital; Novara Italy
| | | | - Barbara Fossati
- Department of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - Pasquale Frascione
- Department of Oncologic Dermatology; Santa Maria and San Gallicano Institute of Dermatology - IRCCS; Rome Italy
| | - Paolo Lisi
- Department of Medical and Surgical Specialities and Public Health; Section of Clinical; Allergological and Venereological Dermatology; University of Perugia; Perugia Italy
| | - Marcello Santini
- Section of Dermatology; Department of Surgical Sciences; University of Parma; Parma Italy
| | | | - Ketty Peris
- Department of Dermatology; University of L'Aquila; L'Aquila Italy
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Zhao B, Ming M, He YY. Suppression of PTEN transcription by UVA. J Biochem Mol Toxicol 2012; 27:184-91. [PMID: 23129115 DOI: 10.1002/jbt.21451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/10/2012] [Accepted: 09/18/2012] [Indexed: 01/10/2023]
Abstract
Although ultraviolet A (UVA; 315-400 nm) has different physical and biological targets than ultraviolet B (UVB; 280-315 nm), the contribution of UVA to skin cancer susceptibility and its molecular basis remain largely unknown. Here we show that chronic UVA radiation suppresses phosphatase and tensin homolog (PTEN) expression at the mRNA level. Subchronic and acute UVA radiation also downregulated PTEN in normal human epidermal keratinocytes, skin culture, and mouse skin. At the molecular level, chronic UVA radiation decreased the transcriptional activity of the PTEN promoter in a methylation-independent manner, whereas it had no effect on the protein stability or mRNA stability of PTEN. In contrast, we found that UVA-induced activation of the Ras/ERK/AKT and NF-кB pathways plays an important role in UV-induced PTEN downregulation. Inhibiting extracellular signal-regulated kinases (ERK) or protein pinase B (AKT) increases PTEN expression. Our findings may provide unique insights into PTEN downregulation as a critical component of UVA's molecular impact during keratinocyte transformation.
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Affiliation(s)
- Baozhong Zhao
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
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Liu W, Wang X, Lai W, Yan T, Wu Y, Wan M, Yi J, Matsui MS. Sunburn protection as a function of sunscreen application thickness differs between high and low SPFs. Photodermatol Photoimmunol Photomed 2012; 28:120-6. [PMID: 22548392 DOI: 10.1111/j.1600-0781.2012.00650.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sunscreens are an important component of healthy sun-protection behavior. To achieve satisfactory protection, sunscreens must be applied consistently, evenly and correctly. Consumers do not apply sunscreen properly and, therefore, do not achieve the protection indicated by the label 'sun protection factor' (SPF). The objective of the present study was to determine the actual sun(burn) protection given by a range of sunscreen application thickness levels for both low and high SPF formulas. SUBJECTS AND METHODS Forty study subjects were recruited from each of three geographical regions in China. Sunscreens with label SPFs of 4, 15, 30, and 55 were tested at application levels of 0.5, 1.0, 1.5, and 2.0 mg/cm(2) in three laboratories using a standard SPF protocol. RESULTS Sunscreens with lower SPFs (4 and 15) showed a linear dose-response relationship with application level, but higher SPF (30 and 55) product protection was exponentially related to application thickness. CONCLUSION Sunscreen protection is not related in one uniform way to the amount of product applied to human skin. Consumers may achieve an even lower than expected sunburn protection from high SPF products than from low SPF sunscreens.
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Affiliation(s)
- Wei Liu
- Department of Dermatology, The Air Force General Hospital, Beijing, China
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Abstract
BACKGROUND High sun exposure is a major risk factor of skin cancer, and physicians are first-line players in a sun-risk prevention campaign. OBJECTIVES To survey medical students at the end of their general medical education about their knowledge and behaviours concerning natural and artificial sun risk and its prevention. METHODS A 32-question survey was e-mailed to fifth or sixth year medical school students or first-year resident, attending residency-exam preparatory courses in Paris. RESULTS Among 1,374 students, 570 (41.7%) completed the questionnaires. General aspects of sun-protection measures were known to >75% but responses to specific questions, mainly the impact of environmental conditions on sun risk, were frequently erroneous. Although most students declared using sunscreen and avoiding peak hours, 39% never or exceptionally (<1/year) performed skin self-examination. Fewer than one-third wore long sleeves or cap/hat in the sun, and tanning beds were used by 13.5%, but their regulations remained unknown by 30-68%. CONCLUSION The sixth year of medical school signals the end of non-specialized training. Students' results and practices were almost comparable to those of the French general population. Medical schools might not be providing adequate sun-protection education programmes, perhaps diminishing the ability of future doctors to educate patients.
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Affiliation(s)
- A Isvy
- Department of Dermatology, Ambroise-Paré University Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, Boulogne-Billancourt, France
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40
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Chesnut C, Kim J. Is there truly no benefit with sunscreen use and Basal cell carcinoma? A critical review of the literature and the application of new sunscreen labeling rules to real-world sunscreen practices. J Skin Cancer 2012; 2012:480985. [PMID: 22649734 DOI: 10.1155/2012/480985] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/29/2012] [Indexed: 11/24/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common human malignancy. Both epidemiological and direct evidence have established ultraviolet (UV) exposure from the sun as the most important risk factor for BCC development. There has only been one randomized and controlled study to examine sunscreen's role in the prevention of BCC, and no significant protective benefit was found. This study did not address four important concepts: sunscreen abuse, sunscreen misuse, sunscreen formulation, and cumulative UV exposure. Thus, the results of this study are difficult to interpret and extrapolate with real-world sunscreen practices.
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Affiliation(s)
- C Garbe
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany.
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Mitchell D, Fernandez A. The photobiology of melanocytes modulates the impact of UVA on sunlight-induced melanoma. Photochem Photobiol Sci 2012; 11:69-73. [DOI: 10.1039/c1pp05146f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Roetzheim RG, Love-Jackson KM, Hunter SG, Lee JH, Chen R, Abdulla R, Wells KJ. A cluster randomized trial of sun protection at elementary schools. Results from year 2. Am J Prev Med 2011; 41:615-8. [PMID: 22099239 PMCID: PMC3223605 DOI: 10.1016/j.amepre.2011.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/15/2011] [Accepted: 08/15/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Elementary schools are one potential venue for sun protection interventions that reduce childhood sun exposure. PURPOSE To assess Year-2 results from a cluster randomized trial promoting hat use at schools. DESIGN Block randomization was used to assign intervention/control status to participating schools. Data were collected from 2006 to 2008 and analyzed in 2007-2010. SETTING/PARTICIPANTS Of the 24 schools in the School District of Hillsborough County, Florida enrolled, 4th-graders were targeted in the first year and followed through their 5th-grade year. INTERVENTION Classroom sessions were conducted to improve sun protection knowledge, foster more positive attitudes about hat use, and change the subjective norm of wearing hats when at school. MAIN OUTCOME MEASURES Year-2 outcomes assessed included hat use at school (measured by direct observation), hat use outside of school (measured by self-report) and skin pigmentation and nevi counts (measured for a subgroup of 439 students). RESULTS The percentage of students observed wearing hats at control schools remained unchanged during the 2-year period (range 0%-2%) but increased significantly at intervention schools (2% at baseline, 41% at end of Year 1, 19% at end of Year 2; p<0.001 for intervention effect). Measures of skin pigmentation, nevi counts, and self-reported use of hats outside of school did not change during the study period. CONCLUSIONS This intervention increased use of hats at school through Year 2 but had no measurable effect on skin pigmentation or nevi. Whether school-based interventions can ultimately prevent skin cancer is uncertain.
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Affiliation(s)
- Richard G Roetzheim
- Department of Family Medicine, University of South Florida,12901 Bruce B.Downs Blvd., Tampa, FL 33612, USA.
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Green AC, Wallingford SC, McBride P. Childhood exposure to ultraviolet radiation and harmful skin effects: epidemiological evidence. Prog Biophys Mol Biol 2011; 107:349-55. [PMID: 21907230 PMCID: PMC3409870 DOI: 10.1016/j.pbiomolbio.2011.08.010] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
We review the general amount and patterns of exposure to solar ultraviolet (UV) radiation that children and teenagers experience and the spectrum of UV-related skin damage that can occur as a result. Data about the amount of solar UV received by children and teenagers are relatively few but suggest that around 40-50% of total UV to age 60 occurs before age 20. Among white children, those with the palest complexions suffer the most damage. Comparisons of prevalence and incidence of outcomes in children and teenagers sharing common ancestry, but living at different latitudes, show that prevalence rates of photoaging and melanocytic naevi are higher in Australian compared with British children, and similarly for melanoma. Genetic risk for the majority of the melanomas in teens is a function of genes controlling naevus propensity and pigmentation in the skin. High numbers of naevi and freckles, red hair, blue eyes, inability to tan, as well as a family history are the primary determinants of melanoma among adolescents. Beyond the signs of skin damage seen in children are the latent effects observed later in adulthood. Childhood is believed to be a susceptible window for long-term harmful effects of UV, as evidenced by clear differences in skin cancer risk between child and adult migrants from high to low latitudes. Effective UV radiation protection from childhood is necessary to control both immediate and long-term harmful effects on children's skin.
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Affiliation(s)
- Adèle C Green
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
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Vilela FMP, Fonseca YM, Jabor JR, Vicentini FTMC, Fonseca MJV. Effect of ultraviolet filters on skin superoxide dismutase activity in hairless mice after a single dose of ultraviolet radiation. Eur J Pharm Biopharm 2011; 80:387-92. [PMID: 22036989 DOI: 10.1016/j.ejpb.2011.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/25/2011] [Accepted: 10/05/2011] [Indexed: 11/24/2022]
Abstract
Organic sunscreens may decrease their protective capability and also behave as photo-oxidants upon ultraviolet radiation (UVR) exposure. The present study investigated the effect of a cream gel formulation containing the UV filters benzophenone-3, octyl methoxycinnamate, and octyl salicylate on skin superoxide dismutase (SOD) after a single dose of UVR (2.87 J/cm(2)). The retention of these UV filters was first evaluated in vivo using hairless mice to guarantee the presence of the filters in the skin layers at the moment of irradiation. The in vivo effect of the UV filters on skin SOD was then assayed spectrophotometrically via the reduction of cytochrome c. The cream gel formulation promoted the penetration of the three UV filters into the epidermis and the dermis at one hour post-application. A significant decrease in SOD activity was observed in irradiated animals treated with sunscreen formulation. However, no effect on SOD activity in skin was observed by the isolated presence of the sunscreens, the formulation components, or the exposure to UVR. The sunscreens may have formed degradation products under UVR that may have either inhibited the enzyme or generated reactive species in the skin.
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Greinert R, Boniol M. Skin cancer--primary and secondary prevention (information campaigns and screening)--with a focus on children & sunbeds. Prog Biophys Mol Biol 2011; 107:473-6. [PMID: 21906618 DOI: 10.1016/j.pbiomolbio.2011.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
Solar and artificial (sunbed) UV-exposure is the main risk factor for the development of epithelial skin cancer (basal cell carcinoma, BCC, and squamous cell carcinoma, SCC) as well for malignant melanoma (MM). UV exposure in childhood and adolescence is especially important. Therefore, adequate methods of primary prevention have continuously to be used and to be developed further to target these age-groups in order to reduce the risks of intensive UV-exposure. Primary prevention can effectively be combined with secondary prevention (early detection, screening) to reduce the burden of skin cancer and to decrease incidence, morbidity and mortality.
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Affiliation(s)
- Rüdiger Greinert
- Department Molecular Cellbiology, Dermatology Center Buxtehude, Elbekliniken Stade/Buxtehude, Klinikum Buxtehude, Buxtehude, Germany.
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Bowen D, Jabson J, Haddock N, Hay J, Edwards K. Skin care behaviors among melanoma survivors. Psychooncology 2011; 21:1285-91. [PMID: 21780240 DOI: 10.1002/pon.2017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/21/2011] [Accepted: 05/25/2011] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Clinical recommendations for survivors of melanoma generally include skin care behaviors, including regular physician and skin self-examination to identify any recurrences or second primary disease early, as well as sun protection. We measured skin care behaviors in a population-based sample of melanoma survivors. METHODS Melanoma survivors were approached through the regional National Cancer Institute-funded cancer registry (Surveillance, Epidemiology, and End Results) and recruited to this study with a response rate of approximately 75%, for a total sample of n = 313. RESULTS The sample was 99% Caucasian, 56% female, 44% male, 81% married, 62% college educated, and 48% with an income over 70 K annually, with an average age of 56 years. Over the last 7 days, a total of 45% reported wearing sunscreen, 59% reported wearing long sleeves, 80% reported wearing pants, 35% reported wearing something on the head, and 36% stayed in available shade. Skin self-examination behaviors were reported at relatively low frequencies, with only 22% performing a thorough check on skin. A total of 88% of survivors reported that their physician checked their skin in the past few years by having all clothes removed. A multivariate analysis using logistic regression indicated that perceived risk was positively related to having the skin checked by a medical provider but no other skin protection behaviors. Gender effects were also detected for wearing sunscreen and wearing a hat or scarf. DISCUSSION Data indicate that melanoma survivors are performing sun protection behaviors to a moderate extent. Future studies can address barriers to consistent use of these behaviors in melanoma survivors.
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Affiliation(s)
- Deborah Bowen
- School of Public Health, Boston University, Boston, MA, USA.
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Abstract
Ultraviolet radiation (UVR) in sunlight has deleterious effects on skin, while behavioural changes have resulted in people gaining more sun exposure. The clinical impact includes a year-on-year increase in skin cancer incidence, and topical sunscreens alone provide an inadequate measure to combat overexposure to UVR. Novel methods of photoprotection are being targeted as additional measures, with growing interest in the potential for systemic photoprotection through naturally sourced nutrients. Omega-3 polyunsaturated fatty acids (n-3 PUFA) are promising candidates, showing potential to protect the skin from UVR injury through a range of mechanisms. In this review, we discuss the biological actions of n-3 PUFA in the context of skin protection from acute and chronic UVR overexposure and describe how emerging new technologies such as nutrigenomics and lipidomics assist our understanding of the contribution of such nutrients to skin health.
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Affiliation(s)
- Suzanne M Pilkington
- Dermatological Sciences, Inflammation Sciences Research Group, School of Translational Medicine, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Hospital, Manchester, UK
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Autier P, Boniol M, Doré JF. Is Sunscreen Use for Melanoma Prevention Valid for All Sun Exposure Circumstances? J Clin Oncol 2011; 29:e425-6; author reply e427. [DOI: 10.1200/jco.2010.34.4275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Mathieu Boniol
- International Prevention Research Institute, Lyon, France
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