Sun-related behaviors among individuals previously diagnosed with non-melanoma skin cancer.

Compared to the general population, the risk of developing non-melanoma skin cancer is considerably higher among individuals with a previous history of this condition. Protection from ultraviolet (UV) radiation is the primary evidence-based approach for minimizing this risk. This review was aimed to assess the prevalence of sun-safe behaviors in non-melanoma skin cancer survivors. Searches were conducted in six electronic databases including PubMed, Psyclnfo, CINAHL, EMBASE, ERIC and Science Direct. A narrative approach was adopted to synthesize the data. The findings demonstrated that respondents do not protect themselves optimally from UV radiation exposure. Low levels of perceived skin cancer risk, a lack of knowledge about effective sun protection strategies and the inconvenience associated with sun-safe behaviors appear to explain this finding. A note of caution is required here, as there is a potential for publication bias. Moreover, the results of this study cannot be generalized to all non-melanoma skin cancer patients. Skin cancer survivors must be educated about their increased risk of future skin cancers. Behavioral interventions must be developed to increase the adoption of skin protective behaviors in this high-risk population group.

Topical photodynamic therapy with methylaminolevulinate for the treatment of actinic keratosis and reduction of photodamage in organ transplant recipients: a case-series of 16 patients.

BACKGROUND: Organ transplant recipients (OTR) are at high risk of developing cutaneous neoplasms. Topical photodynamic therapy (PDT) has been used for the treatment of actinic keratosis (AK) in OTR. AIMS: The objective was to evaluate the efficacy of PDT with methylaminolevulinate (MAL) in the treatment of facial AK in OTR. As a secondary objective, we wanted to evaluate the usefulness of topical PDT in the reduction of photodamage in OTR. METHODS: A prospective, single center, single arm study was made. 16 OTR were included. Topical PDT was applied for 1 or 2 cycles depending on the patient's characteristics. An evaluation of AK was made at visits pre-treatment, at 12 weeks and at 24 weeks. Photodamage was measured with multispectral image technique (SkinCare). RESULTS: A complete response rate of 100% was achieved for AK in all patients; it persisted without change at 12 and 24 weeks of follow-up. 62.5% of patients improved their photodamage as measured by SkinCare®, but this result was not statistically significant (P = 0.12). All patients had high level of satisfaction at the end of the therapy. CONCLUSIONS: MAL-PDT is an effective therapy for the treatment of AK in OTRs. It can reduce photodamage in this group of patients, but these results were not statistically significant.

The development of efficient sunscreens.

Skin exposure to acute or repetitive ultraviolet light induces risks which are now well identified. An efficient photoprotection is thus required for both UVB and UVA radiation. In particular, increasing evidence of the detrimental effects of UVA on skin has led to the development of a new generation of sunscreens that provide effective protection throughout the whole UV radiation spectrum. Many new UV filters have been introduced in the last decade, particularly UVA filters, with improved efficacy and safety. Sunscreen filters must be carefully combined to achieve esthetically pleasing products offering photostable and well-balanced photoprotection.

Photoprotection and vitamin D status: a study on awareness, knowledge and attitude towards sun protection in general population from Kuwait, and its relation with vitamin D levels.

BACKGROUND: The primary cause of skin cancers is exposure to ultraviolet (UV) radiation. And, for decades sun protection has been promoted in various public health education campaigns. Recently, however, vitamin D deficiency has been related to increased risk of skin cancers. And, skin being the primary site for the synthesis of active form of vitamin D, excessive sun protection could lead to vitamin D-deficient states. But, the results have so far been conflicting. AIMS: To study the level of awareness, knowledge and attitude of representative groups from the general population from Kuwait towards sun protection. And, also study the correlation of the level of sun protective measures used and vitamin D levels in these groups. METHODS: The study constituted of two main parts. First part comprised a questionnaire-based survey of representative group of people aged 18 and above to assess their knowledge, awareness and attitude towards sun protection. The second part consisted of measuring serum vitamin D levels in 150 volunteers amongst the responders of the questionnaire, who had been regularly using sunscreens for at least 2 years and compare to the levels seen in 150 age and sex-matched responders of similar skin phototypes, who had never used sunscreens. RESULTS: Out of the total of 1044 responders, 80% of them had adequate knowledge of the beneficial and harmful effects of sun exposure, and had been using sunscreens regularly, and adopting other sun protective measures in their daily life. The levels of vitamin D were found to be deficient in both sunscreen users and those who had never used sunscreens. The difference between the two groups was statistically insignificant (60.67% vs 54.67%; P value>0.001). CONCLUSION: Population at large seems to be adequately informed about the beneficial and deleterious effects of sun exposure. Vitamin D levels are deficient in majority of our people, and there is a need to do larger surveys covering all parts of the country and give supplemental doses of vitamin D to those found deficient.

Skin cancer in skin of color / Skin cancer in skin of color

Skin cancer is less common in persons with skin of color than in light-skinned Caucasians but is often associated with greater morbidity and mortality. Thus, it is crucial that physicians become familiar with skin cancer in persons of color so as to maximize the likelihood of early detection of these tumors. In dark-skinned ethnic groups, squamous cell carcinoma is most common; squamous cell carcinoma and melanoma usually occur on nonsun-exposed sites; and ultraviolet radiation is not an important etiologic factor for skin cancer with the exception of basal cell carcinoma. Races of intermediate pigmentation, such as Hispanics and Asians, share epidemiologic and clinical features of dark-skinned ethnic groups and Caucasians. Skin cancers pose a significant risk in skin of color and clinicians should focus on preventive measures in these groups such as regular skin exams, self-examination, public education, and screening programs. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with the epidemiology and unique clinical features of skin cancer in skin of color and be aware of strategies to prevent skin cancer in skin of color.

Chemoprevention of nonmelanoma skin cancer / Chemoprevention of nonmelanoma skin cancer

Skin cancer is the most common cancer in human beings. The increased incidence of skin cancer has brought much attention to the process by which these tumors develop and how they can be prevented. Efforts have been made to educate the public about the importance of protecting skin from excessive ultraviolet light. Despite this work, the incidence of skin cancer continues to increase. Available compounds may be useful in the chemoprevention of skin cancer. Chemoprevention is defined as oral or topical use of dietary or pharmacologic agents to inhibit or reverse the development of cancer. Potential agents included are the retinoids; difluoromethylornithine; T4 endonuclease V; polyphenolic antioxidants, such as (-)-epigallocatechin gallate, found in green tea and grape seed extract; silymarin; isoflavone genestein; nonsteroidal anti-inflammatory drugs; curcumin; lycopene; vitamin E; beta-carotene; and selenium. Many of these agents are available over the counter as topical or oral preparations. LEARNING OBJECTIVE: At the conclusion of this activity, participants should be familiar with the chemopreventive agents and their efficacy, as well as any significant side effects associated with them...

Different histologic patterns of cutaneous granulomas in systemic lymphoma.

BACKGROUND: Patients with Hodgkin's and non-Hodgkin's lymphomas may develop non-infectious granulomas in both involved and uninvolved organs, but rarely in the skin. Cutaneous granulomas in the setting of a systemic lymphoma are of two types. The first type is characterized by granulomatous infiltrates admixed with neoplastic cells within specific skin lesions of malignant lymphomas. The second type consists of granulomatous skin processes that are non-specific manifestations of the underlying lymphoma. OBJECTIVE: To describe the variegate histologic patterns of cutaneous granulomatous reactions of the second type in patients with systemic lymphomas. METHODS: We describe three patients with systemic lymphomas who exhibited three different histologic patterns of cutaneous granulomatous lesions. RESULTS: The first patient had non-Hodgkin's lymphoma with cutaneous tuberculoid-type granuloma mimicking tuberculoid leprosy; the second patient had Hodgkin's lymphoma with palisaded, necrobiotic granuloma of granuloma annulare-type; and the third patient had non-Hodgkin's lymphoma with sarcoid-type granuloma. No evidence of the underlying systemic lymphoma was found in the cutaneous lesions involved by the granulomatous process. CONCLUSIONS: Cutaneous granulomas may be a non-specific sign of an underlying systemic lymphoma. Their histologic patterns are variegate and include sarcoid-type granuloma, palisaded and necrobiotic granuloma of granuloma annulare-type, and tuberculoid granuloma. In patients who present with non-infectious, granulomatous skin reactions in the absence of another sound explanation, the possibility of a systemic lymphoma should be considered.

[Problems raised by the treatment of Kaposi's sarcoma in subjects with AIDS]. / Problèmes posés par les traitements du sarcome de Kaposi chez les sujets atteints de S. I. D. A.

Kaposi's Syndrome (K. S.) was defined as a virus induced immunogenic tumour responding to interferon. It can be used as a guideline for therapeutical trials in A. I. D. S. K. S. mortality is 13%. K. S. + O. I. (opportunistic infections) mortality reaches 70% and O. I. mortality is approximately 50%. Therefore treating O. I. is a must but it is not mentioned in the paper. Attempts made to modify immunodepression, usual K. S. treatments, experimental treatments based upon similar pathogenicity (like systemic lupus erythematosus, Hansen's disease, preneoplasia dyskeratosis) were unsuccessful. Trials with alpha recombinant interferon realised at the Sloan Kettering Memorial for Cancer in New York are summarized for 74 patients and are in preliminary interpretation. Our study is based upon 13 cases studied for 14 to 4 months and comes up to the same conclusions using 18 to 36 million units/day for 6 months (6 cases) and 3 to 4 months (7 cases). For 6 full treatments the results are: 2 K. S. were cleaned up after 8 and 3 months follow up, 4 K. S. with O. I.: 3 remissions and then relapses and 1 stabilization, for 7 current treatments: 2 had to be discontinued because of bad tolerance, 1 stabilization and 4 remissions. For all treatments a decrease and a lesser gravity of O. I. can be noted during treatment. Besides flu-like syndromes, main clinical side effects, are: asthenia, general condition impairment, 2 fits were observed for which I.N.F. cannot be clearly incriminated. Daily treatment compelling and surveillance are real drawbacks. Different types of better used interferon will probably yield interesting results (40% regression or improvement).