S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma (cSCC) - short version, part 2: epidemiology, surgical and systemic treatment of cSCC, follow-up, prevention and occupational disease.

Actinic keratoses (AKs) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guidelines for actinic keratosis and cutaneous squamous cell carcinoma were developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guidelines are aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AKs and cSCC. The guidelines are also aimed at affected patients, their relatives, policy makers and insurance funds. In the second part, we will address aspects relating to epidemiology, etiology, surgical and systemic treatment of cSCC, follow-up and disease prevention, and discuss AKs and cSCC in the context of occupational disease regulations.

Casting shadows on the prevalence of tanning dependence: an assessment of mCAGE criteria.

Recently more and more studies have reported high prevalence rates for a 'tanning dependence' among tanning bed users. The authors of these studies base their argumentation on a modified (m) version of the CAGE (Cut-down, Annoyed, Guilty and Eye-opener) Criteria, initially used for alcohol addiction. By means of cognitive interviews and a large population survey, we tested the validity of the mCAGE Criteria and the above-mentioned prevalence that was deduced on the basis of rather small collectives. Firstly, it seems that the mCAGE Criteria wording used so far is inconsistent, misleading and intrinsically invalid. Secondly, our population-based data show a much lower percentage (15%) of current sunbed users with potential dependence symptoms than the above-mentioned previously published studies. Thirdly, the usage parameters for most of the supposed 'addicts' do not indicate a substance addiction: 38% of the users with positive scores reported not having visited a tanning studio at all in the previous month, 39% did not use sunbeds regularly and 89% did not show signs of tolerance to UV radiation. The mCAGE Criteria do not seem suitable for assessing tanning dependence.

Sunbed use in German adults: risk awareness does not correlate with behaviour.

In Europe, little is known about the prevalence of indoor tanning. The aims of this study were therefore to estimate the prevalence of sunbed use and to identify risk groups and motives in a population-based survey. The cross-sectional "SUN-Study 2008" ("Sunbed-Use: Needs for Action-Study 2008") was conducted in 2008. A total of 500 adults, aged 18-45 years, were randomly selected and asked about their indoor tanning practices, their motivation and risk perception, and the compliance of staff with international sunbed use recommendations. Forty-seven percent of subjects reported having visited an indoor tanning facility at least once in their lives. Prevalence of use was not reduced in risk groups for skin cancer. Risk awareness of users equalled that of non-users. The poor quality of services and advice provided by many solariums was alarming. It can be concluded that appropriate measures to change tanning habits need to be identified. Legal regulations could be one option.