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Abdel Azim S, Bainvoll L, Vecerek N, DeLeo VA, Adler BL. Sunscreens part 1: Mechanisms and efficacy. J Am Acad Dermatol 2025; 92:677-686. [PMID: 38772426 DOI: 10.1016/j.jaad.2024.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 05/23/2024]
Abstract
As our knowledge of the harmful effects of ultraviolet radiation continues to evolve, sunscreen remains an integral part of a comprehensive photoprotection strategy against multiple endpoints of ultraviolet radiation-mediated damage. Part 1 of this review covers sunscreen active and additive ingredient properties, mechanisms of action and gaps in coverage. Following an overview of sunscreen's efficacy in protecting against sunburn, photocarcinogenesis, photoaging, pigmentary disorders, and idiopathic photodermatoses, we highlight considerations for product use and selection in children and individuals with skin of color.
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Affiliation(s)
- Sara Abdel Azim
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Liat Bainvoll
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Natalia Vecerek
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Nielsen JB, Kristiansen IS, Thapa S. Increasing melanoma incidence with unchanged mortality: more sunshine, better treatment, increased diagnostic activity, overdiagnosis or lowered diagnostic threshold? Br J Dermatol 2024; 191:365-374. [PMID: 38655629 DOI: 10.1093/bjd/ljae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Increasing melanoma incidence with less increasing mortality is observed in several countries. This discrepancy is not well understood. OBJECTIVES In this study, our aim was to discuss factors [ultraviolet radiation (UVR) exposure, melanoma treatment, diagnostic activity, overdiagnosis, pathologists' diagnostic threshold and clinicians' propensity to remove suspect skin lesions] that might influence melanoma incidence and mortality in Denmark. METHODS This was a register study with the number of melanocyte-related lesions and melanoma mortality based on comprehensive national pathology and mortality databases for the period 1999-2019. We investigated melanocyte-related diagnoses and mortality in a population of 5.5 million with a national healthcare system. Age-adjusted melanoma mortality and age-adjusted incidence of benign naevi, atypical lesion, or melanoma in situ and of invasive melanoma were computed for data analysis. RESULTS In total, 1 434 798 biopsies were taken from 704 682 individuals (65% female). The mean age at biopsy was 39.8 years in males and 37.6 in females. In males and females, the incidence of invasive melanoma increased by 87% during the period 1999-2011. During the subsequent period it increased by 9% in males but remained unchanged in females. The incidence of melanoma in situ increased by 476% in males and 357% in females during the study period, while the increases for atypical melanocytic lesions were 1928% and 1686%, respectively. Biopsy rates increased by 153% in males and 118% in females from 1999 through 2011 but fell by 20% in males and 22% in females during the subsequent period. Mortality varied slightly from year to year without any significant time trend for males or females. We identified no evidence of increased UVR exposure over the latest 30 years in Denmark. Immunotherapy of advanced melanoma was introduced in Denmark in 2010 and came into general use in 2014. CONCLUSIONS Comprehensive national data demonstrate increasing melanoma incidence correlated with increasing biopsy rates, but with no change in mortality. Previously suggested explanations for such a trend are a lowered threshold of melanoma diagnosis among pathologists, increased diagnostic activity in the presence of overdiagnosis and improved melanoma treatment. Because the study is observational and we have more explanatory factors than outcomes, the findings do not warrant conclusions about causal relationships.
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Affiliation(s)
- Jesper Bo Nielsen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Ivar Sønbø Kristiansen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Subash Thapa
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
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Harrison SL, Buettner PG, Nowak MJ. Sun-Protective Clothing Worn Regularly during Early Childhood Reduces the Number of New Melanocytic Nevi: The North Queensland Sun-Safe Clothing Cluster Randomized Controlled Trial. Cancers (Basel) 2023; 15:cancers15061762. [PMID: 36980647 PMCID: PMC10046807 DOI: 10.3390/cancers15061762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Numerous pigmented moles are associated with sun exposure and melanomarisk. This cluster randomized controlled trial aimed to determine if sun-protective clothing could prevent a significant proportion of the moles developing in young children (ACTRN12617000621314; Australian New Zealand Clinical Trials Registry. Twenty-five childcare centers in Townsville (19.25° S), Australia, were matched on shade provision and socioeconomic status. One center from each pair was randomized to the intervention arm and the other to the control arm. Children at 13 intervention centers wore study garments and legionnaire hats at childcare and received sun-protective swimwear and hats for home use, while children at the 12 control centers did not. The 1–35-month-old children (334 intervention; 210 control) were examined for moles at baseline (1999–2002) and were re-examined annually for up to 4 years. Both groups were similar at baseline. Children at intervention centers acquired fewer new moles overall (median 12.5 versus 16, p = 0.02; 0.46 versus 0.68 moles/month, p = 0.001) and fewer new moles on clothing-protected skin (6 vs. 8; p = 0.021 adjusted for confounding and cluster sampling) than controls. Intervention children had 24.3% fewer new moles overall (26.5 versus 35) and 31.6% (13 versus 19) fewer moles on clothing-protected skin than controls after 3.5 years. Sunlight’s influence on nevogenesis is mitigated when children regularly wear UPF 30-50+ clothing covering half their body, implying that increased clothing cover reduces melanoma risk. Sun-protective clothing standards should mandate reporting of the percentage of garment coverage for childrenswear.
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Affiliation(s)
- Simone L. Harrison
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Townsville, QLD 4811, Australia
- Australian Institute of Tropical Health and Medicine (AITHM), Townsville, QLD 4811, Australia
- Correspondence: ; Tel.: +61-423489083
| | - Petra G. Buettner
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Townsville, QLD 4811, Australia
- Australian Institute of Tropical Health and Medicine (AITHM), Cairns, QLD 4875, Australia
| | - Madeleine J. Nowak
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Townsville, QLD 4811, Australia
- College of Medicine and Dentistry, James Cook University, Douglas, Townsville, QLD 4811, Australia
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Koumaki D, Papadakis M, Kouloumvakou S, Krasagakis K. Awareness, knowledge, and attitudes towards sun protection among patients with melanoma and atypical mole syndrome. World J Clin Oncol 2022; 13:587-598. [PMID: 36157160 PMCID: PMC9346423 DOI: 10.5306/wjco.v13.i7.587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/18/2022] [Accepted: 06/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with atypical mole syndrome (AMS) have a 3- to 20-fold higher risk of developing malignant melanoma (MM) than individuals without. The most modifiable risk factor for developing MM is the ongoing ultraviolet exposure. AIM To assess awareness, knowledge, and attitudes towards sun protection among patients with MM and AMS. METHODS From January 2020 till December 2021, a written survey was administered to patients with MM and AMS and a control group who attended a specialist mole clinic at the Dermatology Department of the University Hospital of Heraklion in Heraklion, Crete, Greece. Demographic data and photoprotective practices, knowledge, and perceived barriers were collected. Relevant statistical analyses were performed using SPSS IBM 25. RESULTS In total, 121 subjects consented and participated in the survey. Their mean age was 43.92 ± 12.55 years. There were 66 (54.4%) females and 55 (45.4%) males. Forty-seven (38.8%) patients had AMS, 26 (21.5%) had a past medical history of MM, and 48 (39.7%) attended the clinic for a full skin checkup for their naevi without having AMS or MM. Although 104 (86%) participants reported using sunscreen with the majority of them (59/121 = 48.8%) wearing sunscreen with a sun protection factor of > 50, only 22 (18.2%) patients did so every day and only 20 (16.5%) all year round. Approximately 74.4% of patients recalled having received advice on how to protect their skin from sunlight, and 73% were interested in receiving education about sun protection. The most mentioned barriers in photoprotection were concerns over adequate vitamin D and lack of time. CONCLUSION Despite mentioning having received adequate education in photoprotection, adherence to photoprotection practices is suboptimal in patients with MM and AMS.
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Affiliation(s)
- Dimitra Koumaki
- Department of Dermatology, University Hospital of Heraklion, Heraklion 71110, Greece
| | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
| | - Stamatoula Kouloumvakou
- Department of Internal Medicine, Agios Nikolaos General Hospital, Agios Nikolaos 72100, Greece
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Barsoum R, Harrison SL. Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228680. [PMID: 33238422 PMCID: PMC7700251 DOI: 10.3390/ijerph17228680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1–6 and 21–31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups.
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Affiliation(s)
- Ramez Barsoum
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia;
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
- Princess Alexandra Hospital, Queensland Health, Woolloongabba, Brisbane 4102, Australia
| | - Simone L. Harrison
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia;
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
- Correspondence: ; Tel.: +61-(0)423-489-083
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Briceno L, Harrison SL, Heal C, Kimlin M, Paul G. Parametric human modelling to determine body surface area covered by sun-protective clothing. ERGONOMICS 2020; 63:293-306. [PMID: 31795841 DOI: 10.1080/00140139.2019.1699952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
Solar ultraviolet radiation (UVR) is the main environmental risk-factor for cancer of the skin. Sun-protective clothing provides a physical barrier that reduces the UVR dose reaching the skin and European and Australian standards for sun-protective clothing set minimum clothing coverage requirements. Body Surface Area Coverage by clothing (BSAC) is calculated by means of indirect or direct methods, which are laborious and do not support computer-based apparel design. To support the sun-safe specification and design of garments, parametric digital human models and protective clothing mesh covering the minimum Body Surface Area specified in AS/NZS 4399:2017, were created making use of MakeHuman v1.1.1 and Blender software. The Whole Body Surface Area (WBSA) and the BSAC were calculated employing code developed in Blender. Thus, different groups of subjects were analysed to explore BSAC. The method assists in the evaluation of exposed body areas in a wider spectrum of different occupations. Practitioner summary: Sun-protective clothing provides a physical barrier that reduces the UVR dose reaching the skin's surface. Body Surface Area Coverage (BSAC) by clothing is an important determinant of the sun protective capabilities of a garment. In this study, BSAC is calculated using parametric digital human modelling. Abbreviation: UVR: (Solar) ultraviolet radiation; DHM: digital human modeling; BSA: body surface area; BSAC: body surface area coverage (by clothing); BSANC: body surface area not covered (by clothing); WBSA: whole body surface area; BCC: basal cell carcinoma; SCC: squamous cell carcinoma; UPF: ultraviolet protection factor; GPF: garment protection factor.
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Affiliation(s)
- Leyde Briceno
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Mackay, Australia
- James Cook University, Townsville, Australia
| | | | - Clare Heal
- James Cook University, Townsville, Australia
| | - Michael Kimlin
- University of the Sunshine Coast, Sippy Downs, Australia
| | - Gunther Paul
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Mackay, Australia
- James Cook University, Townsville, Australia
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Are Environmental Interventions Targeting Skin Cancer Prevention among Children and Adolescents Effective? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020529. [PMID: 31947667 PMCID: PMC7013813 DOI: 10.3390/ijerph17020529] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022]
Abstract
Skin cancer, which is increasing exceedingly worldwide, is substantially preventable by reducing unprotected exposure to ultraviolet radiation (UVR). Several comprehensive interventions targeting sun protection behaviors among children and adolescents in various outdoor settings have been developed; however, there is a lack of insight on stand-alone effectiveness of environmental elements. To compose future skin cancer prevention interventions optimally, identification of effective environmental components is necessary. Hence, an extensive systematic literature search was conducted, using four scientific databases and one academic search engine. Seven relevant studies were evaluated based on stand-alone effects of various types of environmental sun safety interventions on socio-cognitive determinants, sun protection behaviors, UVR exposure, and incidence of sunburns and nevi. Free provision of sunscreen was most often the environmental component of interest, however showing inconsistent results in terms of effectiveness. Evidence regarding shade provision on shade-seeking behavior was most apparent. Even though more research is necessary to consolidate the findings, this review accentuates the promising role of environmental components in skin cancer prevention interventions and provides directions for future multi-component sun safety interventions targeted at children and adolescents in various outdoor settings.
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Cunningham SA, Yu R, Shete S. Differences in Sun Protection Behaviors Between Rural and Urban Communities in Texas. J Rural Health 2019; 35:155-166. [PMID: 30830988 DOI: 10.1111/jrh.12350] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The increasing incidence of skin cancer is a global health issue. In order to identify at-risk populations in Texas, we compared sun protection behaviors and sunburn history across rural and urban counties. METHODS An online health screening survey collected data from a nonprobability sample of Texas residents in 2018. Data were weighted by sex, age, race, and ethnicity. Multinomial multivariable logistic regression identified key factors associated with sun protection behaviors and sunscreen use. Weighted Pearson's χ2 test identified differences between urban and rural respondents in strength of sunscreen used and sunburn history. FINDINGS Rural residents in Texas were less likely to seek shade (OR = 0.58; P = .004) and less likely to use sunscreen lotion (OR = 0.65; P = .013) compared to their urban counterparts. Sunscreen use was also lower among current versus never smokers (OR = 0.67; P = .034) but higher in those with personal versus no cancer history (OR = 2.14; P = .004). Although rural versus urban residents were more likely to use higher SPF sunscreen (P < .002), they had more blistering sunburns over the course of their life (P < .001) and these injuries were more likely to occur at an earlier age, between 5 and 14 years old (P < .001). CONCLUSIONS Increased attention to sun protective behaviors among rural communities in Texas is vital to help reduce the high prevalence of sunburn injury and incidence of skin cancer.
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Affiliation(s)
- Sonia A Cunningham
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Whiteman DC, Neale RE, Aitken J, Gordon L, Green AC, Janda M, Olsen CM, Soyer HP. When to apply sunscreen: a consensus statement for Australia and New Zealand. Aust N Z J Public Health 2019; 43:171-175. [PMID: 30681231 DOI: 10.1111/1753-6405.12873] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/01/2018] [Accepted: 12/01/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Cancers of the skin are the most common cancers in humans, with Australia and New Zealand having the world's highest incidence. Primary prevention campaigns advise people to apply sunscreen to exposed body sites when outdoors. However, despite growing evidence that cumulative sub-erythemal exposures cause mutational damage, and trial data demonstrating benefit from daily sunscreen use, current policies do not consider the hazards of incidental (everyday) sun exposure. Thus, a Sunscreen Summit was convened to review the evidence and update the policies for people living in Australia and New Zealand. RESULTS After reviewing the benefits and risks of sunscreen application, the policy group concluded that people living in Australia and New Zealand should be advised to apply sunscreen to the face/head/neck and all parts of the body not covered by clothing on all days when the ultraviolet index is forecast to reach three or greater, irrespective of their anticipated activities. For planned outdoors activities, sunscreen should be used alongside other sun protection measures. CONCLUSIONS People living in Australia and New Zealand are now advised to apply sunscreen every day when the UV index is predicted to reach 3 or above. Implications for public health: Increased use of sunscreen as part of the daily routine to reduce incidental sun exposure will lead to decreased incidence of skin cancer in the future.
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Affiliation(s)
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland
| | | | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland
| | - Monika Janda
- The University of Queensland, Brisbane, Queensland
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De Giorgi V, Gori A, Greco A, Savarese I, Alfaioli B, Grazzini M, Rossari S, Papi F, Scarfi F, Janowska A, D’Errico A, Salvati L, Covarelli P, Gandini S. Sun-Protection Behavior, Pubertal Development and Menarche: Factors Influencing the Melanocytic Nevi Development—The Results of an Observational Study of 1,512 Children. J Invest Dermatol 2018; 138:2144-2151. [DOI: 10.1016/j.jid.2018.02.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 11/29/2022]
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Khan AQ, Travers JB, Kemp MG. Roles of UVA radiation and DNA damage responses in melanoma pathogenesis. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2018; 59:438-460. [PMID: 29466611 PMCID: PMC6031472 DOI: 10.1002/em.22176] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 05/10/2023]
Abstract
The growing incidence of melanoma is a serious public health issue that merits a thorough understanding of potential causative risk factors, which includes exposure to ultraviolet radiation (UVR). Though UVR has been classified as a complete carcinogen and has long been recognized for its ability to damage genomic DNA through both direct and indirect means, the precise mechanisms by which the UVA and UVB components of UVR contribute to the pathogenesis of melanoma have not been clearly defined. In this review, we therefore highlight recent studies that have addressed roles for UVA radiation in the generation of DNA damage and in modulating the subsequent cellular responses to DNA damage in melanocytes, which are the cell type that gives rise to melanoma. Recent research suggests that UVA not only contributes to the direct formation of DNA lesions but also impairs the removal of UV photoproducts from genomic DNA through oxidation and damage to DNA repair proteins. Moreover, the melanocyte microenvironment within the epidermis of the skin is also expected to impact melanomagenesis, and we therefore discuss several paracrine signaling pathways that have been shown to impact the DNA damage response in UV-irradiated melanocytes. Lastly, we examine how alterations to the immune microenvironment by UVA-associated DNA damage responses may contribute to melanoma development. Thus, there appear to be multiple avenues by which UVA may elevate the risk of melanoma. Protective strategies against excess exposure to UVA wavelengths of light therefore have the potential to decrease the incidence of melanoma. Environ. Mol. Mutagen. 59:438-460, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Aiman Q Khan
- Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Jeffrey B Travers
- Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio
- Dayton Veterans Affairs Medical Center, Dayton, Ohio
| | - Michael G Kemp
- Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio
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Geller AC, Dickerman BA, Taber JM, Dwyer LA, Hartman AM, Perna FM. Skin cancer interventions across the cancer control continuum: A review of experimental evidence (1/1/2000-6/30/2015) and future research directions. Prev Med 2018; 111:442-450. [PMID: 29425724 PMCID: PMC5930068 DOI: 10.1016/j.ypmed.2018.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/11/2018] [Accepted: 01/29/2018] [Indexed: 12/20/2022]
Abstract
While the general efficacy of skin cancer interventions have been reviewed, employing the cancer control continuum would be useful to identify research gaps at specific cancer control points. We characterized the intervention evidence base for specific behavioral targets (e.g., tanning, sun protection, screening) and clinically related targets (e.g., sunburn, skin exams, cancers) at each point in the cancer control continuum. The review included articles published from 1/1/2000-6/30/15 that had an experimental design and targeted behavioral intervention in skin cancer (e.g., specific behaviors or clinically related targets). The search yielded 86 articles, including seven dissemination studies. Of the 79 non-dissemination studies, 57 exclusively targeted primary prevention behaviors, five exclusively targeted screening, 10 targeted both detection and prevention, and eight addressed cancer survivorship. Among prevention studies (n=67), 29 (43%) targeted children and 38 (57%) targeted adults. Of the 15 screening studies, nine targeted high-risk groups (e.g., men aged ≥50 years) and six targeted the general population. Although research has focused on skin cancer prevention, empirically validated interventions are still needed for youth engaged in indoor tanning and for behavioral interventions to pursue change in clinically relevant targets. Research must also address detection among those at highest risk for skin cancer, amelioration of emotional distress attendant to diagnosis and treatment, and survivorship concerns. We discuss essential qualities and opportunities for intervention development and translational research to inform the field.
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Affiliation(s)
- Alan C Geller
- Harvard TH Chan School of Public Health, United States.
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13
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Kekeç DÖ, Kaçar N, Karaarslan IK. Dermoscopic changes in melanocytic nevi covered with both opaque tape and sunscreen cream during narrowband ultraviolet B therapy. Dermatol Pract Concept 2018; 8:132-139. [PMID: 29785332 PMCID: PMC5955082 DOI: 10.5826/dpc.0802a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/20/2018] [Indexed: 11/26/2022] Open
Abstract
Background Ultraviolet (UV) light may cause dermoscopic changes on melanocytic nevi (MN). Objectives To investigate the effects of sunscreen cream (SSc) application on dermoscopic changes in MN during narrowband UVB (NBUVB) therapy. Methods Half of the randomly selected MN in each patient were covered with opaque tape and SSc [SSc(+)], and the rest were covered with only opaque tape [SSc(−)] during NBUVB treatment sessions. Results More SSc(−) MN displayed dermoscopic changes at end of NBUVB therapy compared to the start of therapy (p=0.035). The number of the MN that decreased in size and showed loss of structure was significantly higher in SSc(−) MN (p=0.04 and p=0.026, respectively). Conclusions Sunscreen in combination with opaque tape may contribute to some dermoscopic changes in melanocytic nevi, including decrease in size and loss of structure.
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Affiliation(s)
| | - Nida Kaçar
- Department of Dermatology, Pamukkale University, Denizli, Turkey
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Papakonstantinou A, Ioannides D, Vakirlis E, Savvoulidis C, Lallas A, Apalla Z, Sotiriou E, Lazaridou E. Dermoscopic features of melanocytic skin lesions in Greek children and adolescents and their association with environmental factors and skin types. J Eur Acad Dermatol Venereol 2018; 32:2142-2148. [PMID: 29633380 DOI: 10.1111/jdv.14996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/15/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acquired naevi often present in childhood and increase in number and size during early and middle life. As naevi represent potential mimickers of melanoma, the knowledge of their epidemiologic and morphologic characteristics is essential. OBJECTIVE In this study, we intend to determine the prevalence of dermoscopic patterns of naevi, as well their association with environmental and constitutional factors. METHODS Cross-sectional data derived from a population-based cohort of children and adolescents aged 6-18 years, from 12 different schools in Thessaloniki, Greece. For each participant, a consent form and a questionnaire were completed, which included data on age, sex, phototype, sun sensitivity, sun exposure, sunscreen use and previous sunburn history. All naevi, their body distribution, and their dermoscopic patterns were recorded. RESULTS Two thousand and five hundred and five (2505) subjects were enrolled into the study (47.8% males and 52.2% females). The mean number of MN counted in a single person was 29.11 (SD = ±23.863). TNC increased continuously with higher age. Males were found to have a significantly increased number on the trunk (11.7 ± 11.2 and 10.0 ± 8.7, respectively, P < 0.001) and face and neck (6.2 ± 5.3 and 5.1 ± 4.3, respectively, P < 0.001) while females on the upper (10.3 ± 10.1 and 9.3 ± 9.4, respectively, P = 0.008) and lower extremities (2.8 ± 3.4 and 2.5 ± 3.2, respectively, P = 0.008). Globular pattern was the most frequent dominant pattern in lower age groups, and its percentage fell as age increased. On the contrary, the reticular pattern was more often documented in individuals in adolescence. CONCLUSION This first study of MN in our young population aims to be the basis of further investigation for the MM preventive policy of our state.
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Affiliation(s)
- A Papakonstantinou
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - D Ioannides
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - E Vakirlis
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - C Savvoulidis
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - A Lallas
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Z Apalla
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - E Sotiriou
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - E Lazaridou
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
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15
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Lingham G, Milne E, Cross D, English DR, Johnston RS, Lucas RM, Yazar S, Mackey DA. Investigating the long-term impact of a childhood sun-exposure intervention, with a focus on eye health: protocol for the Kidskin-Young Adult Myopia Study. BMJ Open 2018; 8:e020868. [PMID: 29391375 PMCID: PMC5829843 DOI: 10.1136/bmjopen-2017-020868] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Excessive and insufficient sun exposure during childhood have been linked to serious diseases in later life; for example, insufficient sun exposure during childhood may increase the risk of developing myopia. The Kidskin-Young Adult Myopia Study (K-YAMS) is a follow-up of participants in the Kidskin Study, a non-randomised controlled trial that evaluated the effect of a 4-year educational intervention on sun-protection behaviours among primary school children in the late 1990s. Children who received the Kidskin intervention had lower levels of sun exposure compared with peers in the control group after 2 and 4 years of the intervention, but this was not maintained 2 years after the intervention had ceased. Thus, a follow-up of Kidskin Study participants provides a novel opportunity to investigate the associations between a childhood sun-exposure intervention and potentially related conditions in adulthood. METHODS AND ANALYSIS The K-YAMS contacts Kidskin Study participants and invites them to participate using a variety of methods, such as prior contact details, the Australian Electoral Roll and social media. Self-reported and objective measures of sun-exposure and sun-protection behaviours are collected as well as a number of eye measurements including cycloplegic autorefraction and ocular biometry. Data will be analysed to investigate a possible association between myopic refractive error and Kidskin intervention group or measured sun exposure. ETHICS AND DISSEMINATION The K-YAMS is approved by the Human Research Ethics Committee of the University of Western Australia (RA/4/1/6807). Findings will be disseminated via scientific journals and conferences. TRIAL REGISTRATION NUMBER ACTRN12616000812392; Pre-results.
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Affiliation(s)
- Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Elizabeth Milne
- Telethon Kids Institute, University of Western Australia, West Perth, Western Australia, Australia
| | - Donna Cross
- Telethon Kids Institute, University of Western Australia, West Perth, Western Australia, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn S Johnston
- McCusker Centre for Action on Alcohol and Youth, Curtin University, Bentley, Western Australia, Australia
| | - Robyn M Lucas
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
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16
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Martin-Gorgojo A, Llinares M, Virós A, Requena C, Garcia-Casado Z, Traves V, Kumar R, Nagore E. Cutaneous melanoma primary site is linked to nevus density. Oncotarget 2017; 8:98876-98886. [PMID: 29228734 PMCID: PMC5716774 DOI: 10.18632/oncotarget.22016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022] Open
Abstract
There are at least two pathways driving cutaneous melanoma; one is linked to an inherent melanoma susceptibility to nevi development and the second to environmental cumulative ultraviolet light exposure. In this study, we examined the relation between nevus density, accrued sun damage and the site of primary melanoma excision. In a series of 888 consecutive cutaneous melanoma patients, melanomas appearing in skin areas with a high relative nevus density were most prominent in men, with an elevated nevus count, at sites without solar elastosis, but with an epidemiological history of previous sunburn. The present study associates melanoma development to sites with high nevus density. Our study supports more careful surveillance of body areas with increased nevus density in patients with high total body number of nevi, especially when they report a history of sunburns at these sites.
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Affiliation(s)
| | - Marta Llinares
- Department of Dermatology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Amaya Virós
- Skin Cancer and Ageing Laboratory, CRUK Manchester Institute, Manchester, UK
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Zaida Garcia-Casado
- Department of Molecular Biology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Víctor Traves
- Department of Pathology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Rajiv Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
- Dermatology Department, School of Medicine, Universidad Católica de València “San Vicente Mártir”, Valencia, Spain
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17
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Hollestein L, Weinstock M, Le Roux E, Olsen C. More Than Many: How to Manage the Most Frequent Cancer? J Invest Dermatol 2017; 137:1823-1826. [PMID: 28843292 DOI: 10.1016/j.jid.2017.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
Leiter et al. report on the increasing incidence of keratinocyte cancers in Germany. The true population burden is even larger then reported, because many of these new patients will develop multiple keratinocyte cancers. Keratinocyte cancer puts a large burden on health care systems worldwide. Prevention and management strategies are needed to maintain high quality of care for all patients.
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Affiliation(s)
- Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands.
| | - Martin Weinstock
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Emma Le Roux
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Catherine Olsen
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia; School of Public Health, University of Queensland, Queensland, Australia
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18
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Armstrong BK, Cust AE. Sun exposure and skin cancer, and the puzzle of cutaneous melanoma: A perspective on Fears et al. Mathematical models of age and ultraviolet effects on the incidence of skin cancer among whites in the United States. American Journal of Epidemiology 1977; 105: 420-427. Cancer Epidemiol 2017; 48:147-156. [PMID: 28478931 DOI: 10.1016/j.canep.2017.04.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 11/19/2022]
Abstract
Sunlight has been known as an important cause of skin cancer since around the turn of the 20th Century. A 1977 landmark paper of US scientists Fears, Scotto, and Schneiderman advanced a novel hypothesis whereby cutaneous melanoma was primarily caused by intermittent sun exposure (i.e. periodic, brief episodes of exposure to high-intensity ultraviolet radiation) while the keratinocyte cancers, squamous cell carcinoma and basal cell carcinoma, were primarily caused by progressive accumulation of sun exposure. With respect to cutaneous melanoma, this became known as the intermittent exposure hypothesis. The hypothesis stemmed from analysis of measured ambient ultraviolet radiation and age-specific incidence rates of melanoma and keratinocyte cancers collected as an extension to the US Third National Cancer Survey in several US States. In this perspective paper, we put this novel hypothesis into the context of knowledge at the time, and describe subsequent epidemiological and molecular research into melanoma that elaborated the intermittent exposure hypothesis and ultimately replaced it with a dual pathway hypothesis. Our present understanding is of two distinct biological pathways by which cutaneous melanoma might develop; a nevus prone pathway initiated by early sun exposure and promoted by intermittent sun exposure or possibly host factors; and a chronic sun exposure pathway in sun sensitive people who progressively accumulate sun exposure to the sites of future melanomas.
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Affiliation(s)
- Bruce K Armstrong
- Cancer Epidemiology and Prevention Research Group, School of Public Health, The University of Sydney, NSW, Australia; School of Global and Population Health, The University of Western Australia, Perth, WA, Australia.
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research Group, School of Public Health, The University of Sydney, NSW, Australia; The Melanoma Institute Australia, North Sydney, NSW, Australia
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19
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Jha D, Jha S, Ghosh S, Smylie M, Taher M. Sun-Smart Practices Amongst School Students (Grades 5, 7, and 9) in Alberta, Canada. J Cutan Med Surg 2017; 21:137-144. [DOI: 10.1177/1203475417692574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to assess the current knowledge children possess on melanoma and sun-protective behaviour. Methods: A one-page survey was administered to students in grades 5, 7, and 9. Results: Three hundred ninety-two students from 11 schools in Edmonton were surveyed. Seventy-one percent of students knew that sun exposure can cause skin cancers. Sixty-nine percent were taught by their parents about sun protection, but only 44% of students received similar instructions from teachers. Twenty percent of students indicated that they never or rarely wore sunscreen. Twenty-five percent of students had experienced painful sunburns, and only 46% were willing to use sunscreen if it were available at school. More Caucasian students reported painful or peeling sunburns in each grade level than their non-Caucasian peers (for grade 5, P = .003; for grade 7, P < .0001; for grade 9, P = .001). For all grade levels, the percentage of Caucasian students who indicated that they would not wear sunscreen when going out in the sun was greater than among their non-Caucasian peers (for grade 5, P < .001; for grade 7, P = .003; for grade 9, P = .015). Conclusions: A comprehensive and focused approach to sun-smart education is recommended for students.
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Affiliation(s)
- Divya Jha
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Shankar Jha
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | - Michael Smylie
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Muba Taher
- Department of Dermatology, University of Alberta, Edmonton, AB, Canada
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20
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Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. J Am Acad Dermatol 2017; 76:S100-S109. [DOI: 10.1016/j.jaad.2016.09.038] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/19/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
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21
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Cestari T, Buster K. Photoprotection in specific populations: Children and people of color. J Am Acad Dermatol 2017; 76:S110-S121. [PMID: 28038884 DOI: 10.1016/j.jaad.2016.09.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/19/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Improved education on appropriate photoprotection in children is vital. Photoprotection for these individuals should include seeking shade, the use of physical agents (clothing, hat, sunglasses), and application of sunscreens on exposed areas. Avoidance of the use of tanning beds is an important component of education for teenagers. Ultraviolet radiation exposure induces DNA damage and photoaging in all skin types, including people of color. The extent of such damage is inversely related to constitutive skin pigmentation. Therefore, personalized photoprotection recommendations concerning skin cancer risk factors, desired treatment outcomes, health needs (eg, vitamin D), and photoaging based on the needs and preferences of the patient are essential. It is clear that additional research is needed on optimal levels of protection against ultraviolet radiation for people of color.
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Affiliation(s)
- Tania Cestari
- Department of Dermatology, Federal University of Rio Grande do Sul, School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Kesha Buster
- Buster Dermatology, Tulsa, Oklahoma; University of Alabama at Birmingham, Birmingham, Alabama
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22
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Wang SQ, Xu H, Stanfield JW, Osterwalder U, Herzog B. Comparison of ultraviolet A light protection standards in the United States and European Union through in vitro measurements of commercially available sunscreens. J Am Acad Dermatol 2017; 77:42-47. [PMID: 28238452 DOI: 10.1016/j.jaad.2017.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The importance of adequate ultraviolet A light (UVA) protection has become apparent in recent years. The United States and Europe have different standards for assessing UVA protection in sunscreen products. OBJECTIVE We sought to measure the in vitro critical wavelength (CW) and UVA protection factor (PF) of commercially available US sunscreen products and see if they meet standards set by the United States and the European Union. METHODS Twenty sunscreen products with sun protection factors ranging from 15 to 100+ were analyzed. Two in vitro UVA protection tests were conducted in accordance with the 2011 US Food and Drug Administration final rule and the 2012 International Organization for Standardization method for sunscreen effectiveness testing. RESULTS The CW of the tested sunscreens ranged from 367 to 382 nm, and the UVA PF of the products ranged from 6.1 to 32. Nineteen of 20 sunscreens (95%) met the US requirement of CW >370 nm. Eleven of 20 sunscreens (55%) met the EU desired ratio of UVA PF/SPF > 1:3. LIMITATIONS The study only evaluated a small number of sunscreen products. CONCLUSION The majority of tested sunscreens offered adequate UVA protection according to US Food and Drug Administration guidelines for broad-spectrum status, but almost half of the sunscreens tested did not pass standards set in the European Union.
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Affiliation(s)
- Steven Q Wang
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Haoming Xu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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23
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Ghiasvand R, Weiderpass E, Green AC, Lund E, Veierød MB. Sunscreen Use and Subsequent Melanoma Risk: A Population-Based Cohort Study. J Clin Oncol 2016; 34:3976-3983. [DOI: 10.1200/jco.2016.67.5934] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose To assess melanoma risk in relation to sunscreen use and to compare high– with low–sun protection factor (SPF) sunscreens in relation to sunbathing habits in a large cohort study. Materials and Methods We used data from the Norwegian Women and Cancer Study, a prospective population-based study of 143,844 women age 40 to 75 years at inclusion with 1,532,247 person-years of follow-up and 722 cases of melanoma. Multivariable Cox proportional hazards regression was used to estimate the association between sunscreen use (never, SPF < 15, SPF ≥ 15) and melanoma risk by calculating hazard ratios and 95% CIs. The population attributable fraction associated with sunscreen use was estimated. Results Sunscreen users reported significantly more sunburns and sunbathing vacations and were more likely to use indoor tanning devices. SPF ≥ 15 sunscreen use was associated with significantly decreased melanoma risk compared with SPF < 15 use (hazard ratio, 0.67; 95% CI, 0.53 to 0.83). The estimated decrease in melanoma (population attributable fraction) with general use of SPF ≥ 15 sunscreens by women age 40 to 75 years was 18% (95% CI, 4% to 30%). Conclusion Use of SPF ≥ 15 rather than SPF < 15 sunscreens reduces melanoma risk. Moreover, use of SPF ≥ 15 sunscreen by all women age 40 to 75 years could potentially reduce their melanoma incidence by 18%.
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Affiliation(s)
- Reza Ghiasvand
- Reza Ghiasvand and Marit B. Veierød, Institute of Basic Medical Sciences, University of Oslo; Elisabete Weiderpass, Cancer Registry of Norway, Oslo; Elisabete Weiderpass and Eiliv Lund, University of Tromsø–The Arctic University of Norway, Tromsø, Norway; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland; Adele C. Green, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; and Adele C. Green,
| | - Elisabete Weiderpass
- Reza Ghiasvand and Marit B. Veierød, Institute of Basic Medical Sciences, University of Oslo; Elisabete Weiderpass, Cancer Registry of Norway, Oslo; Elisabete Weiderpass and Eiliv Lund, University of Tromsø–The Arctic University of Norway, Tromsø, Norway; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland; Adele C. Green, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; and Adele C. Green,
| | - Adele C. Green
- Reza Ghiasvand and Marit B. Veierød, Institute of Basic Medical Sciences, University of Oslo; Elisabete Weiderpass, Cancer Registry of Norway, Oslo; Elisabete Weiderpass and Eiliv Lund, University of Tromsø–The Arctic University of Norway, Tromsø, Norway; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland; Adele C. Green, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; and Adele C. Green,
| | - Eiliv Lund
- Reza Ghiasvand and Marit B. Veierød, Institute of Basic Medical Sciences, University of Oslo; Elisabete Weiderpass, Cancer Registry of Norway, Oslo; Elisabete Weiderpass and Eiliv Lund, University of Tromsø–The Arctic University of Norway, Tromsø, Norway; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland; Adele C. Green, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; and Adele C. Green,
| | - Marit B. Veierød
- Reza Ghiasvand and Marit B. Veierød, Institute of Basic Medical Sciences, University of Oslo; Elisabete Weiderpass, Cancer Registry of Norway, Oslo; Elisabete Weiderpass and Eiliv Lund, University of Tromsø–The Arctic University of Norway, Tromsø, Norway; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland; Adele C. Green, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; and Adele C. Green,
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Abstract
The North American public maintains an attitude that equates the acquisition of a suntan with health. However, prolonged exposure to ultraviolet radiation from the sun can lead to sunburn, premature skin aging, immunosuppression, and skin cancer. Misconceptions about the risks of tanning beds and the effectiveness of sunscreens are common. The public must be better informed about the importance of and the need for effective sun protection by means of clothing and hats, the proper use of sunscreen, and the avoidance of prolonged sun exposure during the time of maximal solar insolation.
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Affiliation(s)
- Jason K. Rivers
- From the Department of Dermatology, Faculty of Medicine, University of British Columbia, and Skin Care Centre, Vancouver General Hospital, Vancouver, BC; Division of Dermatology, McGill University, Royal Victoria Hospital, Montréal, PQ; and Division of Dermatology, University of Montréal, Sainte-Justine Hospital, Montréal, PQ
| | - Beatrice Wang
- From the Department of Dermatology, Faculty of Medicine, University of British Columbia, and Skin Care Centre, Vancouver General Hospital, Vancouver, BC; Division of Dermatology, McGill University, Royal Victoria Hospital, Montréal, PQ; and Division of Dermatology, University of Montréal, Sainte-Justine Hospital, Montréal, PQ
| | - Danielle Marcoux
- From the Department of Dermatology, Faculty of Medicine, University of British Columbia, and Skin Care Centre, Vancouver General Hospital, Vancouver, BC; Division of Dermatology, McGill University, Royal Victoria Hospital, Montréal, PQ; and Division of Dermatology, University of Montréal, Sainte-Justine Hospital, Montréal, PQ
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25
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Scope A, Marchetti MA, Marghoob AA, Dusza SW, Geller AC, Satagopan JM, Weinstock MA, Berwick M, Halpern AC. The study of nevi in children: Principles learned and implications for melanoma diagnosis. J Am Acad Dermatol 2016; 75:813-823. [PMID: 27320410 PMCID: PMC5030195 DOI: 10.1016/j.jaad.2016.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
Abstract
Melanocytic nevi are a strong phenotypic marker of cutaneous melanoma risk. Changes in nevi during childhood and adolescence make these prime periods for studying nevogenesis. Insights gained by the study of nevi in childhood have implications for melanoma detection in both adults and children. A more comprehensive understanding of the morphologic characteristics of nevi in different anatomic locations, in association with the patient's age and pigmentary phenotype may aid in the identification of melanomas. When monitoring melanocytic lesions over time, it is essential to differentiate normal from abnormal change. This review summarizes the rapidly expanding body of literature relevant to nevus phenotype, particularly in the context of our experience with the Study of Nevi in Children (SONIC) Project.
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Affiliation(s)
- Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan C Geller
- Harvard School of Public Health, Social and Behavioral Sciences, Boston, Massachusetts
| | - Jaya M Satagopan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin A Weinstock
- Dermatoepidemiology Unit, Veteran's Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
| | - Marianne Berwick
- Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, New Mexico
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Ho BK, Reidy K, Huerta I, Dilley K, Crawford S, Hultgren BA, Mallett KA, Turrisi R, Robinson JK. Effectiveness of a Multicomponent Sun Protection Program for Young Children: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:334-42. [PMID: 26857829 PMCID: PMC5522744 DOI: 10.1001/jamapediatrics.2015.4373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Emphasizing sun protection behaviors among young children may minimize sun damage and foster lifelong sun protection behaviors that will reduce the likelihood of developing skin cancer, especially melanoma. OBJECTIVE To determine whether a multicomponent sun protection program delivered in pediatric clinics during the summer could increase summertime sun protection among young children. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled clinical trial with 4-week follow-up that included 300 parents or relatives (hereafter simply referred to as caregivers [mean age, 36.0 years]) who brought the child (2-6 years of age) in their care to an Advocate Medical Group clinic during the period from May 15 to August 14, 2015. Of the 300 caregiver-child pairs, 153 (51.0%) were randomly assigned to receive a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors (intervention group) and 147 (49.0%) were randomly assigned to receive the information usually provided at a well-child visit (control group). Data analysis was performed from August 20 to 30, 2015. INTERVENTION Multicomponent sun protection program composed of a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors. MAIN OUTCOMES AND MEASURES Outcomes were caregiver-reported use of sun protection by the child (seeking shade and wearing sun-protective clothing and sunscreen) using a 5-point Likert scale, duration of outdoor activities, and number of children who had sunburn or skin irritation. The biologic measurement of the skin pigment of a child's arm was performed with a spectrophotometer at baseline and 4 weeks later. RESULTS Of the 300 caregiver-child pairs, the 153 children in the intervention group had significantly higher scores related to sun protection behaviors on both sunny (mean [SE], 15.748 [0.267] for the intervention group; mean [SE], 14.780 [0.282] for the control group; mean difference, 0.968) and cloudy days (mean [SE], 14.286 [0.282] for the intervention group; mean [SE], 12.850 [0.297] for the control group; mean difference, 1.436). Examination of pigmentary changes by spectrophotometry revealed that the children in the control group significantly increased their melanin levels, whereas the children in the intervention group did not have a significant change in melanin level on their protected upper arms (P < .001 for skin type 1, P = .008 for skin type 2, and P < .001 for skin types 4-6). CONCLUSIONS AND RELEVANCE A multicomponent intervention using text-message reminders and distribution of read-along books and swim shirts was associated with increased sun protection behaviors among young children. This was corroborated by a smaller change in skin pigment among children receiving the intervention. This implementable program can help augment anticipatory sun protection guidance in pediatric clinics and decrease children's future skin cancer risk. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02376517.
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Affiliation(s)
- Byron K. Ho
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katie Reidy
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Imelda Huerta
- Advocate Children’s Hospital, Park Ridge and Oak Lawn, Illinois
| | | | - Susan Crawford
- Advocate Children’s Hospital, Park Ridge and Oak Lawn, Illinois
| | - Brittney A. Hultgren
- Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park
| | - Kimberly A. Mallett
- Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park
| | - Rob Turrisi
- Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park
| | - June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois4Editor, JAMA Dermatology
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Naldi L, Cazzaniga S. Prediction of high total naevus count to estimate melanoma risk. We need more, don't we? Br J Dermatol 2016; 174:261-2. [PMID: 26871917 DOI: 10.1111/bjd.14334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- L Naldi
- Centro Studi GISED, via Garibaldi 13/15, 24100, Bergamo, Italy.,Department of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S Cazzaniga
- Centro Studi GISED, via Garibaldi 13/15, 24100, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital, Bern, Switzerland
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28
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Nazir A, Saleem MA, Nazir F, Hussain T, Faizan MQ, Usman M. Comparison of UV Protection Properties of Cotton Fabrics Treated with Aqueous and Methanolic Extracts of Achyranthes aspera and Alhagi maurorum Plants. Photochem Photobiol 2016; 92:343-347. [PMID: 26756318 DOI: 10.1111/php.12566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/30/2015] [Indexed: 11/29/2022]
Abstract
UV radiations are high-energy radiations present in sunlight that can damage human skin. Protection against these radiations becomes vital especially in those areas of the globe where UV index is quite high that makes the inhabitants more prone to dangerous effects of UV radiations. Clothing materials are good blockers of UV radiations, particularly when the fabric cover factor is high and/or the fabrics contain suitable UV-blocking finishes. In this study, effect of application of aqueous and methanolic extracts of two different plants, i.e., Achyranthes aspera and Alhagi maurorum on UV protection properties of cotton fabric was investigated. The results showed that the fabric samples treated with extracts of both the plants have excellent UV protection properties as indicated by their ultraviolet protection factor. It was concluded that both the aqueous and methanolic plant extracts are very effective in blocking UVA and UVB radiations, when applied on cotton fabrics. The UV protection performance of Achyranthes aspera extracts was much better as compared to that of Alhagi maurorum, and methanolic extracts of both the plants outperformed the aqueous extracts in terms of UV protection.
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Affiliation(s)
- Ahsan Nazir
- Faculty of Engineering and Technology, National Textile University, Faisalabad, Pakistan
| | - Muhammad Asad Saleem
- Faculty of Engineering and Technology, National Textile University, Faisalabad, Pakistan
| | - Faiza Nazir
- Department of Chemistry, Government College Women University Faisalabad, Faisalabad, Pakistan
| | - Tanveer Hussain
- Faculty of Engineering and Technology, National Textile University, Faisalabad, Pakistan
| | - Muhammad Qasim Faizan
- Faculty of Engineering and Technology, National Textile University, Faisalabad, Pakistan
| | - Muhammad Usman
- Faculty of Engineering and Technology, National Textile University, Faisalabad, Pakistan
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29
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Skin lesion tracking using structured graphical models. Med Image Anal 2016; 27:84-92. [DOI: 10.1016/j.media.2015.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 01/09/2015] [Accepted: 03/08/2015] [Indexed: 11/20/2022]
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30
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Berwick M, Buller DB, Cust A, Gallagher R, Lee TK, Meyskens F, Pandey S, Thomas NE, Veierød MB, Ward S. Melanoma Epidemiology and Prevention. Cancer Treat Res 2016; 167:17-49. [PMID: 26601858 DOI: 10.1007/978-3-319-22539-5_2] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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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31
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Higgins HW, Lee KC, Galan A, Leffell DJ. Melanoma in situ: Part I. Epidemiology, screening, and clinical features. J Am Acad Dermatol 2015; 73:181-90, quiz 191-2. [PMID: 26183967 DOI: 10.1016/j.jaad.2015.04.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/18/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022]
Abstract
The incidence of melanoma has steadily increased over the past 3 decades, with melanoma in situ comprising a disproportionately high percentage of the rising incidence. Our understanding of melanoma in situ has been shaped by epidemiologic and clinical studies. Central to a review of melanoma in situ is a focus on its epidemiology, pathology, biologic behavior, treatment, and clinical outcome, which may differ significantly from that of malignant melanoma. Part I of this continuing medical education article reviews the epidemiology, risk factors, and clinical features of melanoma in situ; part II covers the histopathology, treatment options, and clinical management.
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Affiliation(s)
- H William Higgins
- Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island.
| | - Kachiu C Lee
- Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island
| | - Anjela Galan
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - David J Leffell
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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32
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Satagopan JM, Oliveria SA, Arora A, Marchetti MA, Orlow I, Dusza SW, Weinstock MA, Scope A, Geller AC, Marghoob AA, Halpern AC. Sunburn, sun exposure, and sun sensitivity in the Study of Nevi in Children. Ann Epidemiol 2015; 25:839-43. [PMID: 26096189 DOI: 10.1016/j.annepidem.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/28/2015] [Accepted: 05/15/2015] [Indexed: 01/11/2023]
Abstract
PURPOSE To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural logarithm scale; log nevi) and the role of sun sensitivity. METHODS We describe an analysis of cross-sectional data from 443 children enrolled in the prospective Study of Nevi in Children. To evaluate the joint effect, we partitioned the sum of squares because of interaction between sunburn and sun exposure into orthogonal components representing (1) monotonic increase in log nevi with increasing sun exposure (rate of increase of log nevi depends on sunburn), and (2) nonmonotonic pattern. RESULTS In unadjusted analyses, there was a marginally significant monotonic pattern of interaction (P = .08). In adjusted analyses, sun exposure was associated with higher log nevi among those without sunburn (P < .001), but not among those with sunburn (P = .14). Sunburn was independently associated with log nevi (P = .02), even though sun sensitivity explained 29% (95% confidence interval: 2%-56%, P = .04) of its effect. Children with high sun sensitivity and sunburn had more nevi, regardless of sun exposure. CONCLUSIONS A program of increasing sun protection in early childhood as a strategy for reducing nevi, when applied to the general population, may not equally benefit everyone.
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Affiliation(s)
- Jaya M Satagopan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Susan A Oliveria
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Arshi Arora
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin A Weinstock
- Dermatoepidemiology Unit, VA Medical Center, Providence, RI; Department of Dermatology, Rhode Island Hospital, Providence, RI; Department of Dermatology, Brown University, Providence, RI; Department of Epidemiology, Brown University, Providence, RI
| | - Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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33
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Palmieri G, Colombino M, Casula M, Budroni M, Manca A, Sini MC, Lissia A, Stanganelli I, Ascierto PA, Cossu A. Epidemiological and genetic factors underlying melanoma development in Italy. Melanoma Manag 2015; 2:149-163. [PMID: 30190844 PMCID: PMC6094587 DOI: 10.2217/mmt.15.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Among human cancers, melanoma remains one of the malignancies with an ever-growing incidence in white populations. Recent advances in biological and immunological therapeutic approaches as well as increased efforts for secondary prevention are contributing to improve the survival rates. It is likely that a significant fall in mortality rates for melanoma will be achieved by further increase of the early detection through a more accurate selection of the higher-risk individuals (i.e., carriers of predisposing genetic alterations). A similar scenario occurs in Italy. In the present review, we have considered data on incidence, survival and mortality rates of melanoma in Italian population, including evaluation of the main risk factors and genetic mutations underlying disease susceptibility.
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Affiliation(s)
- Giuseppe Palmieri
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Maria Colombino
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Milena Casula
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Mario Budroni
- Department of Pathology, Hospital-University Health Unit (AOU), Sassari, Italy
| | - Antonella Manca
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Maria Cristina Sini
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Amelia Lissia
- Department of Pathology, Hospital-University Health Unit (AOU), Sassari, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo Tumori (IRST), Meldola, Italy
| | - Paolo A Ascierto
- Istituto Nazionale Tumori (INT), Fondazione G. Pascale, Naples, Italy
| | - Antonio Cossu
- Department of Pathology, Hospital-University Health Unit (AOU), Sassari, Italy
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34
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Nasti TH, Cochran JB, Tsuruta Y, Yusuf N, McKay KM, Athar M, Timares L, Elmets CA. A murine model for the development of melanocytic nevi and their progression to melanoma. Mol Carcinog 2015; 55:646-58. [PMID: 25788145 PMCID: PMC4575238 DOI: 10.1002/mc.22310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/22/2015] [Accepted: 02/06/2015] [Indexed: 01/25/2023]
Abstract
Acquired melanocytic nevi are commonly found in sun exposed and unexposed human skin, but the potential for their transformation into invasive melanoma is not clear. Therefore, a mouse model of nevus initiation and progression was developed in C3H/HeN mice using a modified chemical carcinogenesis protocol. Nevi develop due to DNA damage initiated by dimethylbenz(a) anthracene (DMBA) followed by chronic promotion with 12‐O‐tetradecanoyl‐phorbol‐13‐acetate (TPA). Dysplastic pigmented skin lesions appeared in 7–9 wk with 100% penetrance. Nests of melanocytic cells appeared in a subset of skin draining lymph nodes (dLN) by 25 wk, but not in age matched controls. Immunohistochemistry, real‐time PCR, and flow cytometric analyses confirmed their melanocytic origin. Transformed cells were present in a subset of nevi and dLNs, which exhibited anchorage‐independent growth, tumor development, and metastasis in nude mice. Approximately 50% of the cell lines contained H‐Ras mutations and lost tumor suppressor p16Ink4a expression. While most studies of melanoma focus on tumor progression in transgenic mouse models where the mutations are present from birth, our model permits investigation of acquired mutations at the earliest stages of nevus initiation and promotion of nevus cell transformation. This robust nevus/melanoma model may prove useful for identifying genetic loci associated with nevus formation, novel oncogenic pathways, tumor targets for immune‐prevention, screening therapeutics, and elucidating mechanisms of immune surveillance and immune evasion. © 2015 The Authors. Molecular Carcinogenesis, published by Wiley Periodicals, Inc.
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Affiliation(s)
- Tahseen H Nasti
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - J Barry Cochran
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Yuko Tsuruta
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Skin Diseases Research Center, and The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Nabiha Yusuf
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Skin Diseases Research Center, and The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Birmingham VA Medical Center, Birmingham, Alabama
| | - Kristopher M McKay
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Mohammad Athar
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Skin Diseases Research Center, and The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Laura Timares
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Skin Diseases Research Center, and The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Birmingham VA Medical Center, Birmingham, Alabama
| | - Craig A Elmets
- The Department of Dermatology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Skin Diseases Research Center, and The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,The Birmingham VA Medical Center, Birmingham, Alabama
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35
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Abstract
A new or changing melanocytic nevus in a child or adolescent often leads to concern in parents and physicians. To avoid undue alarm and unnecessary procedures, dermatologists should be aware of the natural history and clinical spectrum of nevi in pediatric patients, as well as findings that are potentially worrisome in this age group. This review provides an update on melanocytic nevi in children, focusing on their dynamic evolution over time, molecular insights into nevogenesis, and phenotypic markers for increased risk of melanoma in adolescence and adulthood. Special considerations for Spitz nevi and nevi located in particular sites (eg, scalp, acral, genital) are highlighted. Current understanding of the risks associated with congenital melanocytic nevi of different sizes and strategies for the management of children with numerous acquired nevi, Spitz nevi, and congenital nevi are also discussed.
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36
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Mirzaalian H, Lee TK, Hamarneh G. Spatial normalization of human back images for dermatological studies. IEEE J Biomed Health Inform 2014; 18:1494-501. [PMID: 25014946 DOI: 10.1109/jbhi.2013.2288775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A large number of pigmented skin lesions (PSLs) are a strong predictor of malignant melanoma. Many dermatologists advocate total body photography for high-risk patients because detecting new-appearing, disappearing, and changing PSL is important for early detection of the disease. However, manual inspection and matching of PSL is a subjective, tedious, and error-prone task. A computer program for tracking the corresponding PSL will greatly improve the matching process. In this paper, we describe the construction of the first human back template (atlas), which is used to facilitate spatial normalization of the PSL during the matching process. Four pairs of anatomically meaningful landmarks (neck, shoulder, armpit, and hip points) are used as reference points on the back image. Using the landmarks, a grid with longitudes and latitudes is constructed and overlaid on each subject-specific back image. To perform spatial normalization, the grid is registered into the back template, a unit-square rectilinear grid. To demonstrate the benefits of using the back template, we apply several state-of-the-art point-matching algorithms on 56 pairs of real dermatological images and show that utilizing spatially normalized coordinates improves the PSL matching accuracies.
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37
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Gilaberte Y, Carrascosa J. Realidades y retos de la fotoprotección en la infancia. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2013.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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38
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Gilaberte Y, Carrascosa J. Sun Protection in Children: Realities and Challenges. ACTA ACUST UNITED AC 2014; 105:253-62. [DOI: 10.1016/j.adengl.2013.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 05/12/2013] [Indexed: 12/18/2022]
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39
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O’Leary RE, Diehl J, Levins PC. Update on tanning: More risks, fewer benefits. J Am Acad Dermatol 2014; 70:562-8. [DOI: 10.1016/j.jaad.2013.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/05/2013] [Accepted: 11/10/2013] [Indexed: 01/14/2023]
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40
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Iannacone MR, Hughes MCB, Green AC. Effects of sunscreen on skin cancer and photoaging. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2014; 30:55-61. [DOI: 10.1111/phpp.12109] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Michelle R. Iannacone
- Cancer and Population Studies Group; Royal Brisbane Hospital; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - Maria Celia B. Hughes
- Cancer and Population Studies Group; Royal Brisbane Hospital; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - Adèle C. Green
- Cancer and Population Studies Group; Royal Brisbane Hospital; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
- Manchester Academic Health Science Center; Institute of Inflammation and Repair; University of Manchester; Manchester UK
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41
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Bevers TB, Brown PH, Maresso KC, Hawk ET. Cancer Prevention, Screening, and Early Detection. ABELOFF'S CLINICAL ONCOLOGY 2014:322-359.e12. [DOI: 10.1016/b978-1-4557-2865-7.00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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42
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Smith A, Harrison S, Nowak M, Buettner P, MacLennan R. Changes in the pattern of sun exposure and sun protection in young children from tropical Australia. J Am Acad Dermatol 2013; 68:774-83. [DOI: 10.1016/j.jaad.2012.10.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/25/2012] [Accepted: 10/27/2012] [Indexed: 10/27/2022]
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43
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Cestari TF, Oliveira FBD, Boza JC. Considerations on photoprotection and skin disorders. Ann Dermatol Venereol 2013; 139 Suppl 4:S135-43. [PMID: 23522628 DOI: 10.1016/s0151-9638(12)70125-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Excessive exposure to solar or artificial sources of UV radiation is deleterious to the skin and can cause or worsen several diseases. Detrimental effects of UV radiation exert an important role in the development of skin cancers, cause alterations on the immune response, and act as a trigger or aggravating factor for pigmentary disorders. A group of measures, including education, change of habits, use of physical barriers and sunscreens constitutes a significant part of the treatment of many skin disorders and are valuable preventive tools. This article summarizes the relevant studies addressing these issues, emphasizing the many aspects of photoprotection.
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Affiliation(s)
- T Ferreira Cestari
- Department of Dermatology, Federal University of Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Brazil.
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44
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Abstract
We formulate the pigmented-skin-lesion (PSL) matching problem as a relaxed labeling of an association graph. In this graph labeling problem, each node represents a mapping between a PSL from one image to a PSL in the second image and the optimal labels are those optimizing a high order Markov Random Field energy (MRF). The energy is made up of unary, binary, and ternary energy terms capturing the likelihood of matching between the points, edges, and cliques of two graphs representing the spatial distribution of the two PSL sets. Following an exploration of various MRF energy terms, we propose a novel entropy energy term encouraging solutions with low uncertainty. By interpreting the relaxed labeling as a measure of confidence, we further leverage the high confidence matching to sequentially constrain the learnt objective function defined on the association graph. We evaluate our method on a large set of synthetic data as well as 56 pairs of real dermatological images. Our proposed method compares favorably with the state-of-the-art.
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de Maleissye MF, Beauchet A, Saiag P, Corrêa M, Godin-Beeckmann S, Haeffelin M, Mahé E. Sunscreen use and melanocytic nevi in children: a systematic review. Pediatr Dermatol 2013; 30:51-9. [PMID: 22994908 DOI: 10.1111/j.1525-1470.2012.01847.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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Wang SQ, Tanner PR, Lim HW, Nash JF. The evolution of sunscreen products in the United States – a 12-year cross sectional study. Photochem Photobiol Sci 2013; 12:197-202. [DOI: 10.1039/c2pp25112d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cestari TF, de Oliveira FB, Boza JC. [Considerations on photoprotection and skin disorders]. Ann Dermatol Venereol 2012; 139 Suppl 3:S83-91. [PMID: 23260523 DOI: 10.1016/s0151-9638(12)70116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Excessive exposure to solar or artificial sources of UV radiation is deleterious to the skin and can cause or worsen several diseases. Detrimental effects of UV radiation exert an important role in the development of skin cancers, cause alterations on the immune response, and act as a trigger or aggravating factor for pigmentary disorders. A group of measures, including education, change of habits, use of physical barriers and sunscreens constitutes a significant part of the treatment of many skin disorders and are valuable preventive tools. This article summarizes the relevant studies addressing these issues, emphasizing the many aspects of photoprotection.
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Affiliation(s)
- T Ferreira Cestari
- Service de dermatologie, Federal University of Rio Grande do Sul ; Hospital de Clinicas de Porto Alegre, Brésil.
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Sunscreen use and availability among female collegiate athletes. J Am Acad Dermatol 2012; 67:876.e1-6. [DOI: 10.1016/j.jaad.2011.11.962] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/15/2011] [Accepted: 11/27/2011] [Indexed: 11/22/2022]
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Crane LA, Asdigian NL, Barón AE, Aalborg J, Marcus AC, Mokrohisky ST, Byers TE, Dellavalle RP, Morelli JG. Mailed intervention to promote sun protection of children: a randomized controlled trial. Am J Prev Med 2012; 43:399-410. [PMID: 22992358 PMCID: PMC3888436 DOI: 10.1016/j.amepre.2012.06.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 03/09/2012] [Accepted: 06/18/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sun exposure, especially during childhood, is the most important preventable risk factor for skin cancer, yet few effective interventions to reduce exposure exist. PURPOSE To test the effectiveness of a partially tailored mailed intervention based on the Precaution Adoption Process Model, delivered in the spring over 3 years to parents and children. DESIGN RCT, with data collection through telephone interviews of parents and skin exams of children at baseline (Summer 2004) and annually (Summer 2005-2007). The control group received no intervention. SETTING/PARTICIPANTS Families recruited in the Denver CO area, through private pediatric clinics, a large MCO, and community settings. Children born in 1998 were approximately 6 years of age at baseline; 867 children met inclusion criteria; analysis is reported for 677 white, non-Hispanic participants at highest risk for skin cancer. MAIN OUTCOME MEASURES Primary outcomes were parent-reported child sun protection behaviors. Secondary outcomes included parents' risk perception, perceived effectiveness of and barriers to prevention behaviors, stage of change, reported sunburns, and observed tanning and nevus development. The longitudinal mixed-model analysis was conducted between 2008 and 2011. RESULTS The intervention group reported more use of sunscreen, protective clothing, hats, shade-seeking, and midday sun avoidance; fewer sunburns; more awareness of the risk of skin cancer; higher perceived effectiveness of sun protection; higher stage of change; and lower perception of barriers to sun protection (all p<0.05). The intervention group had fewer nevi ≥2 mm in 1 year of the study, 2006 (p=0.03). No differences were found in tanning or nevi <2 mm. CONCLUSIONS The level of behavior change associated with this single-modality intervention is not likely sufficient to reduce skin cancer risk. However, the intervention shows promise for inclusion in longer-term, multicomponent interventions that have sufficient intensity to affect skin cancer incidence.
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Affiliation(s)
- Lori A Crane
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era: part I. Historical, histologic, and clinical aspects. J Am Acad Dermatol 2012; 67:1.e1-16; quiz 17-8. [PMID: 22703915 PMCID: PMC3625372 DOI: 10.1016/j.jaad.2012.02.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/14/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
Abstract
Since its description in the 1970s, the dysplastic nevus has been a source of confusion, and whether it represents a precursor to melanoma remains a controversial subject. Although a Consensus Conference in 1992 recommended that the term "dysplastic nevus" no longer be used, the histologic diagnosis continues to present a therapeutic quandary for dermatologists and other physicians, and there remains significant variation in clinical management. In part I of this continuing medical education review, we will discuss the historical origins of the term, the evidence for its distinct histologic basis, and its clinical significance.
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Affiliation(s)
- Keith Duffy
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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