Skin Cancer and Skin Cancer Risk Factors in Sexual and Gender Minorities.

Sexual and gender minorities have unique risk factors that may increase their risk of developing skin cancer. In particular, sexual minority men report a higher prevalence of skin cancer (including both keratinocytes carcinomas and melanoma), higher rates of indoor tanning, and overall poorer sun protection behaviors. Sexual and gender minorities also have high rates of alcohol and tobacco use, and infection with human immunodeficiency virus and human papillomavirus, which may increase overall risk of developing skin cancer in these populations. In this review, we discuss the evidence surrounding skin cancer and associated risk factors among sexual and gender minorities.

Trainee Exposure and Education for Minimally Invasive Gender-Affirming Procedures.

Minimally invasive gender-affirming procedures (MIGAPs), which aim to align gender identity and expression for transgender and gender-nonbinary patients in a way that is safe, effective, and semipermanent or reversible, are gaining in popularity. This article assesses the current amount of trainee exposure in clinic and didactic sessions in core procedural specialties nationwide via survey study of program directors. Low exposure of residents and fellows to MIGAPs was observed overall and a lack of procedure-specific education. In an effort to provide excellent patient care, promote cultural humility, and improve patients' quality of life, further education regarding these procedures is necessary.

Role of human papillomavirus in cutaneous squamous cell carcinoma: a meta-analysis.

BACKGROUND: The role of human papillomavirus (HPV) in cutaneous squamous cell carcinoma (cuSCC) is not well defined, with past studies showing conflicting results. OBJECTIVE: We sought to determine if there is a significant association between HPV and cuSCC and whether cuSCC from immunosuppressed patients are more likely to carry HPV than cuSCC from immunocompetent patients. METHODS: We performed a systematic review and abstracted data from articles that included: skin samples by biopsy, HPV detection by polymerase chain reaction, and a minimum of 10 cases and 10 controls. Pooled effect size and 95% confidence intervals were calculated using random effects meta-analysis using the inverse variance method. RESULTS: cuSCC were more likely to carry HPV than normal-appearing skin (pooled effect size [ES] 3.43, 95% confidence interval 1.97-5.98, P < .0001) in all patients. An increase in HPV prevalence was found in tumors from immunosuppressed patients compared with immunocompetent patients (pooled ES 3.01, 95% confidence interval 2.00-4.52, P < .0001). LIMITATIONS: The greatest limitation is the heterogeneity of the studies included. The association of higher HPV prevalence in squamous cell carcinoma compared with normal-appearing skin does not imply causality. CONCLUSION: These results contribute to evidence that HPV is associated with cuSCC. Higher HPV burden in tumors from immunosuppressed patients compared with immunocompetent patients may have therapeutic implications.

Voriconazole-associated cutaneous malignancy: a literature review on photocarcinogenesis in organ transplant recipients.

This article synthesizes the current data regarding the implication of voriconazole in the development of skin cancer in organ transplant recipients (OTRs) and offers suggestions for additional research. According to Organ Procurement and Transplantation Network data, 28 051 solid organ transplants were performed in 2012. Due to advancements in immunosuppression and management of infectious diseases, survival of OTRs has substantially increased. Voriconazole is a widely prescribed antifungal medication used for prophylaxis and for treatment of invasive fungal infections in OTRs. Case reports describing skin cancer associated with voriconazole exposure emerged shortly after US Food and Drug Administration approval of the drug, and it is now established that voriconazole is an independent risk factor for the development of cutaneous malignancy in lung transplant recipients. The mechanism of voriconazole-induced skin cancer is still unknown and may involve its primary metabolite, voriconazole N-oxide. Here we discuss the current data and potential mechanisms of voriconazole-associated photosensitivity and carcinogenesis and identify areas that require further research.

Validation of a diagnostic microarray for human papillomavirus: coverage of 102 genotypes.

Papillomaviruses have been implicated in a variety of human diseases ranging from common warts to invasive carcinoma of the anogenital mucosa. Existing assays for genotyping human papillomavirus are restricted to a small number of types. Here, we present a comprehensive, accurate microarray strategy for detection and genotyping of 102 human papillomavirus types and validate its use in a panel of 91 anal swabs. This array has equal performance to traditional dot blot analysis with the benefits of added genotype coverage and the ability to calibrate readout over a range of sensitivity or specificity values.

Cancer-Associated Fibroblasts Are Activated in Incipient Neoplasia to Orchestrate Tumor-Promoting Inflammation in an NF-kappaB-Dependent Manner.

Cancer-associated fibroblasts (CAFs) support tumorigenesis by stimulating angiogenesis, cancer cell proliferation, and invasion. We demonstrate that CAFs also mediate tumor-enhancing inflammation. Using a mouse model of squamous skin carcinogenesis, we found a proinflammatory gene signature in CAFs isolated from dysplastic skin. This signature was maintained in CAFs from subsequent skin carcinomas and was evident in mammary and pancreatic tumors in mice and in cognate human cancers. The inflammatory signature was already activated in CAFs isolated from the initial hyperplastic stage in multistep skin tumorigenesis. CAFs from this pathway promoted macrophage recruitment, neovascularization, and tumor growth, activities that are abolished when NF-kappaB signaling was inhibited. Additionally, we show that normal dermal fibroblasts can be "educated" by carcinoma cells to express proinflammatory genes.

Persistent delayed-type hypersensitivity reaction to injectable non-animal-stabilized hyaluronic acid.

OBJECTIVE: Injectable hyaluronic acid is a glycosaminoglycan used for soft-tissue augmentation. A number of products that are not Food and Drug Administration (FDA) approved for use in the United States are used commonly in Europe. We report a case of persistent delayed-type hypersensitivity to injected non-animal-stabilized hyaluronic acid. The patient was initially injected in Europe with a non-FDA-approved filler but traveled to the United States for evaluation of this adverse reaction. METHODS: A case of adverse reaction to non-animal-stabilized hyaluronic acid is described. An overview of selected hyaluronic acid filler products is provided. RESULTS: The patient developed persistent facial edema after injection of hyaluronic acid filler to the melolabial folds, glabella, lips, and perioral rhytids. CONCLUSION: Injectable hyaluronic acid can be associated with a variety of complications including immediate and delayed-type hypersensitivity reactions. Physicians should be familiar with products used in other countries, as patients may present for evaluation following adverse reaction to fillers obtained abroad or from American physicians using non-FDA-approved products.

Scurvy: a presenting sign of psychosis.

Nutritional deficiency may be a presenting sign of undiagnosed psychiatric illness. In this case, we present a patient with scurvy as a complication of fixed psychotic delusions regarding his diet. Dermatologists may play a crucial role in the recognition of psychiatric illnesses and appropriate referral for care.

Diagnosis of lymphoma in the draining lymph node basin at the time of in-transit metastasis of cutaneous melanoma.

The association between cutaneous melanoma and non-Hodgkin's lymphoma (NHL) has been described. Herein we describe two cases in which lymphoma was detected in the draining lymph node basin at the time of the finding of in-transit metastasis of cutaneous melanoma. In both of these cases, sentinel lymph node biopsy at the time of the excision of the primary melanoma showed no evidence of metastatic melanoma or lymphoma. The temporal and spatial correlation of melanoma and NHL in these two cases suggests the possibility of a local failure in immune surveillance.

Impact of thymectomy on the peripheral T cell pool in rhesus macaques before and after infection with simian immunodeficiency virus.

The goal of this study was to define, by surgical removal of the thymus in juvenile rhesus macaques, the role of the thymus in peripheral T cell homeostasis and to assess the significance of thymic output in SIV infection. By monitoring the changes in phenotypic T cell markers as well as in the numbers of TCR excisional circles--a recently described marker for recent thymic emigrants--following thymectomy, we present evidence that surgical thymectomy in juvenile macaques results in a faster decay of peripheral CD4(+) cells, but does not cause a substantial shift in CD45RA(+) and CD45RA(-) populations. We were able to measure a thymic output of 0.32% and 0.21% per day of CD4(+) and CD8(+) cells, respectively. No compensatory extra-thymic source was detected in lymphoid tissues, although there was a small compensatory increase in T cell proliferation in the peripheral T cell pool. After SIV infection, thymectomized animals did not have higher viral loads, greater T cell decay, or faster disease progression. We therefore conclude that peripheral destructive processes, rather than a loss of thymic output, appear to be the main causes of T cell depletion in SIV infection.