Evaluation of a school-based sun safety education program in Reunion Island, 2016-2017.

BACKGROUND: Sun exposure, especially during childhood, is the main environmental risk factor for skin cancers. This study evaluated the impact of the school-based sun safety education program "Living with the Sun" on the knowledge and behavior of primary school children regarding sun safety in Reunion Island. METHODS: This multicenter, comparative intervention study was conducted in selected primary schools of Reunion during the 2016-2017 school year. The intervention consisted of an in-class slide-show presentation on sun safety, a teaching guide, and school trips during which children were offered sunscreen and were requested to wear sunglasses, a T-shirt, and a cap. The children completed a questionnaire before and after the intervention. The percentage of children wearing a cap in school playgrounds at the end of the school year was compared between paired intervention and control schools. RESULTS: Seven hundred children from 7 Reunionese schools completed the questionnaire before and after the intervention. There was a statistically significant improvement in children's knowledge of sun safety, with differences between schools, teachers, school levels, and questionnaire responses. The percentage of children wearing a cap at the end of the school year was significantly higher in intervention schools compared to control schools. CONCLUSIONS: Children's knowledge and behavior regarding sun safety improved significantly as a result of the intervention.

Sun-protection practices among undergraduates at an Australian University.

BACKGROUND/OBJECTIVES: To assess the sun-protection practices of undergraduates at the Australian National University. METHODS: We sent emails with links to the questionnaire on the use of five sun-protection practices in the last fortnight of the summer to 3341 randomly selected students aged 18-24 years in this cross-sectional study. The response rate was 19% and 507 students met the inclusion criteria. RESULTS: The sample consisted of 338 female and 169 male students with a mean age of 20.5 years (SD ± 1.9). Any method of sun protection was used always or often by 32% of respondents. The commonest method used was shade (58%) while the least common was wearing a hat (8%). Domestic students (44%) used sunglasses more than the international students (23%, P < 0.05) and female students used sunscreen (48%) and sunglasses (37%) more than male students (33% and 23% respectively) (P < 0.05). In the 22-24-year-old age group non-medical students (54%) used sunglasses more than the medical students (36%, P < 0.05). CONCLUSIONS: Only a third of the sample practiced any method of sun protection and there were significant differences in the practices between subgroups, suggesting they were at an increased risk of sun damage.

A new sunscreen application technique to protect more efficiently from ultraviolet radiation.

BACKGROUND: UV radiation protection is an important health issue. Sophisticated sunscreen formulations have been developed to improve compliance. However, sunscreen is still inadequately applied, leaving large body areas without effective protection. AIM: This study aims to validate a newly developed sunscreen application technique for adults and children. METHODS: Fifty-eight volunteers were recruited to participate in a monocenter, intraindividual, sequential, comparative study. The covering potential of their currently used sunscreen application technique and of a newly developed systematized application technique (Dose, Apply, Spread) were compared. Evaluation criteria included the amount of product applied, the homogeneity of sunscreen application as measured by the Wood's lamp, and the volunteers' appreciation of the new technique. RESULTS: Fifty-eight volunteers participated in the study: 20 women, 19 men, and 19 children. Respecting the new application technique resulted in a statistically significant (P < 0.05) more evenly spread sunscreen on the different parts of the body and an increase in the amount of product applied. Furthermore, the body surface area covered was significantly increased (P < 0.05), and the new technique was well perceived and accepted by the volunteers. CONCLUSION: The proposed new application technique ensures that more sunscreen will be used and that it will be applied more evenly. Educational work could help improve the efficient use of sunscreens, therefore providing better UV protection.

Antioxidant response and quality of sunburn Beurré D'Anjou pears (Pyrus communis L.).

Sunburn is a physiological fruit disorder induced by exposure to excessive solar radiation. This disorder leads to significant losses in the yield of marketable fruits by negatively affecting quality parameters such as maturity and external color of the fruits. The purpose of this work was to characterize the physiological and biochemical aspects related to oxidative metabolism in Beurré D'Anjou pear fruit with different sunburn levels. Fruits were collected and classified into three sunburn levels at harvest: no sunburn (S0), mild sunburn (S1), and moderate sunburn (S2). On sunburned area, the maturity indices were measured on the fruit flesh, while external color, photosynthetic and photoprotective pigments, total phenols, electrolyte leakage, lipid peroxidation, antioxidant capacity and antioxidant enzymatic activities were determined on fruit peel. The hue angle and saturation of peel color of pears with different sunburn levels showed significant reduction with increasing damage. These changes in peel color were associated with a reduction in chlorophyll content and variations in carotenoid and anthocyanin levels. Due to metabolic changes resulting from defense and adaptive responses to high solar radiation, sunburned tissues showed significantly increased firmness, soluble solids content, and starch degradation, and lower acidity compared to undamaged fruits. We observed also increased antioxidant capacity in the peel of S1 and S2 fruit, related to higher phenolic contents and increased SOD and APX activities. Consistent with previous reports in apple, our study demonstrates that sunburn affects pear fruit quality traits and maturity state by enhancing oxidative metabolism.

Analyzing the relationship between the efficacy of first-line immune checkpoint inhibitors and cumulative sun damage in Japanese patients with advanced BRAF wild-type nonacral cutaneous melanoma: A retrospective real-world, multicenter study.

BACKGROUND: Efficacy of anti-PD-1 antibody monotherapy (PD1) or anti-PD-1 plus anti-CTLA-4 combination therapy (PD1 +CTLA4) for melanoma is affected by its clinical subtype. The amount of tumor mutation burden (TMB) caused by cumulative sun damage (CSD) is occasionally used to explain this; however, their relationship in Japanese nonacral cutaneous melanoma (NACM) is still unclear. OBJECTIVE: To analyze the ICI efficacy and its relationship with CSD of the primary lesion in Japanese patients with NACM. METHODS: Japanese patients with advanced BRAF wild-type NACM who received first-line ICIs were recruited. Objective response rate (ORR), progression-free survival (PFS), and overall survival (OS), and the degree of solar elastosis (SE) were evaluated. RESULTS: A total of 146 patients (PD1 group 113 and PD1 +CTLA4 group 33) were included. No significant differences in ORR were observed between the PD1 and PD1 +CTLA4 groups (35 % vs. 36 %; P = 0.67) or PFS and OS (median PFS 6.1 months vs. 8.5 months; P = 0.46, median OS 28.1 months vs. not reached; P = 0.59). Multivariate survival analysis revealed that PD1 +CTLA4 did not prolong the PFS and OS. The SE score had no effect on either PFS or OS. CONCLUSIONS: ICI efficacy was not as high as those reported in Western countries, and PD1 +CTLA4 did not present better clinical efficacy compared to PD1. Indicators of CSD did not serve as a predictor for clinical advantage. These findings may partially support the theory that ICI efficacy is affected by CSD; however, other unrecognized factors may also exist.

Orange palpebral spots: A case presentation.

Orange palpebral spots are described as bilateral, ovoid, poorly defined orange-yellow macules on the superior eyelid and are predominantly reported in Caucasian populations. Previous reports have found correlations with melatonin incontinence secondary to trauma, lipofuscin accumulation in patients with superficial fatty tissue and palpebral thinness, and vitamin E, carotenoid and beta-cryptoxanthin levels. We present, to our knowledge, the first case of orange palpebral spots reported in the United Kingdom, in a patient with a background of atopy, significant sun exposure, bilateral cataracts and retinal detachment. The 59-year-old male initially presented with a dorsal nasal lesion with the differential: basal cell/trichoblastic carcinoma. During his excisional Mohs surgery, bilateral orange-yellow discolourations of the superior palpebrae were noted. The history was not significant for consumption of dietary sources of pigmentation, such as carotenoids, xanthophylls and vitamin E - found in green leafy vegetables and nut oils, respectively. The age of onset was unknown. A diagnostic skin punch biopsy was suggestive of orange palpebral spots and showed thinning of the epidermis, high-situated superficial and mature fat cells, with minimal pigment incontinence and perivascular lymphocytic infiltration. In addition, solar elastoses were identified on histology. After review in our local clinic-pathological meeting and of the published literature, a diagnosis of orange palpebral spots was given. The pathogenesis of orange palpebral spots remains to be elucidated. The role of sun exposure as a contributing factor to the generation of orange palpebral spots is therefore discussed.

Impact of Social Media on Skin Cancer Prevention.

Despite the increasing prevalence of social media usage in health care contexts, its impact on skin cancer prevention and awareness has not been largely investigated. We conducted a review of literature on this topic with the objective of summarizing and analyzing the role of social media in skin cancer and sun damage awareness and to identify the uses, benefits, and limitations of different social media platforms on skin cancer prevention. In today's technological society, it is critical to understand and study the best form of communication. Specific platforms like Instagram, Twitter, Facebook, YouTube, and TikTok vary in originators of material, target demographics, messaging strategies, and reliability of information with regards to skin cancer, sun, and indoor tanning damage. Our results demonstrate that social media interventions have shown promise in skin cancer prevention and continue to escalate by the day. Dermatologists should keep pace with the latest dermatological content on social media and examine its evolution to target the right audience with the proper messages. Further research is needed to evaluate the effectiveness and true impact of social media on meaningful and lasting behavior change for skin cancer prevention.

Tumor genetic heterogeneity analysis of chronic sun-damaged melanoma.

Chronic sun-damaged (CSD) melanoma represents 10%-20% of cutaneous melanomas and is characterized by infrequent BRAF V600E mutations and high mutational load. However, the order of genetic events or the extent of intra-tumor heterogeneity (ITH) in CSDhigh melanoma is still unknown. Ultra-deep targeted sequencing of 40 cancer-associated genes was performed in 72 in situ or invasive CMM, including 23 CSDhigh cases. In addition, we performed whole exome and RNA sequencing on multiple regions of primary tumor and multiple in-transit metastases from one CSDhigh melanoma patient. We found no significant difference in mutation frequency in melanoma-related genes or in mutational load between in situ and invasive CSDhigh lesions, while this difference was observed in CSDlow lesions. In addition, increased frequency of BRAF V600K, NF1, and TP53 mutations (p < .01, Fisher's exact test) was found in CSDhigh melanomas. Sequencing of multiple specimens from one CSDhigh patient revealed strikingly limited ITH with >95% shared mutations. Our results provide evidence that CSDhigh and CSDlow melanomas are distinct molecular entities that progress via different genetic routes.

Sunlight radiation as a villain and hero: 60 years of illuminating research.

In the 60 years since the inaugural edition of the International Journal of Radiation Biology, much of our understanding of the biological effects of solar radiation has changed. Earlier in the century, sunlight played a 'hero's' role in reducing disabling rickets, while today debate still continues on the amount of sun required before exposure reveals the 'villainous' side of solar radiation. Although knowledge of the ultra violet (UV) component of sunlight as a carcinogen has become widespread, skin cancer rates are still rising yearly. Twentieth century attitudes have seen an about-face in the field of dermatological sun protection, with sunscreens changing from recipes designed to promote a 'healthy tan' to formulations proven to block both ultraviolet B (UVB) and more recently, ultraviolet A (UVA), to minimize premature sun-aging and skin cancer risk. In the early 1960s, DNA was first found to exist within mitochondria, while recently the connections between mitochondrial changes and UV radiation exposure have been expanded. Sixty years ago, understanding of the endocrine systems of mammals was enjoying its infancy. Early discoveries that light, particularly natural light, could have profound effects on functions such as sleep patterns and hormonal balance were made, while today more advanced knowledge has led to lighting improvements having pronounced effects on human wellbeing. Photosensitization 60 years ago was a health concern for both humans and their domestic animals, while today chemically engineered photosensitizing drugs can be administered along with highly directed light to pinpoint delivery targets for drug action. Life on earth is inextricably bound up with solar radiation. This article attempts to outline many of the ways in which our opinions about solar radiation have changed since the journal's inception.

Quality of Life, Behaviour and Attitudes towards Actinic Keratosis in Spain: The PIQA Study. / Calidad de vida, comportamiento y actitudes hacia la queratosis actínica en España: estudio PIQA.

OBJECTIVE: This study was aimed to examine patients' knowledge, behaviours and attitudes regarding actinic keratosis (AK) lesions and the impact of the disease on patients' quality of life (QoL). METHODS: Observational study of patients with AK lesions in Spain. QoL was evaluated with the validated version of Spanish AKQoL questionnaire. Skin self-examination, sun-exposure, habits and attitudes towards AK's treatment were recorded using different questionnaires. The adherence was assessed by means of the Morisky-Green test. Among other variables, QoL and adherence to treatment were compared by using Pearson's χ2 test and one-way ANOVA tests. Inferential analysis regarding such factors and length of treatment were also performed. RESULTS: A total of 1240 patients (73.6 [10.5] years old) were recruited. Overall, patients that showed higher levels of concern were also showed a higher impairment on QoL. AK had greater effects on women's QoL and those who performed skin self-examination, think that AK is a disease and/or believe that moisturizers can prevent skin aging (P<.05). Adherence and length of treatment were strongly related, since patients with treatments intended for <1week were more likely to show good adherence and complete remission of AK (Odds Ratio [95%CI]: 6.25 [4.55-8.33] and 2.63 [1.96-3.45]), respectively). CONCLUSIONS: Concerns due to AK are mainly related to sex and to the consideration of AK as a disease. More concerned patients tend to have lower QoL and good adherence to treatment. Short length of treatment was associated with better adherence and complete remission of AK lesions.

Trihydroxybenzoic acid glucoside as a global skin color modulator and photo-protectant.

BACKGROUND: 3,4,5-Trihydroxybenzoic acid glucoside (THBG), a molecule produced by an original biocatalysis-based technology, was assessed in this study with respect to its skin photoprotective capacity and its skin color control property on Asian-type skin at a clinical level and on skin explant culture models. METHODS: The double-blinded clinical study was done in comparison to a vehicle by the determination of objective color parameters thanks to recognized quantitative and qualitative analysis tools, including Chroma-Meter, VISIA-CR™, and SIAscope™. Determination of L* (brightness), a* and b* (green-red and blue-yellow chromaticity coordinates), individual typology angle, and C* (chroma) and h* (hue angle) parameters using a Chroma-Meter demonstrated that THBG is able to modify skin color while quantification of ultraviolet (UV) spots by VISIA-CR™ confirmed its photoprotective effect. The mechanism of action of THBG molecule was determined using explant skin culture model coupled to histological analysis (epidermis melanin content staining). RESULTS: We have demonstrated that THBG was able to modulate significantly several critical parameters involved in skin color control such as L* (brightness), a* (redness), individual typology angle (pigmentation), and hue angle (yellowness in this study), whereas no modification occurs on b* and C* parameters. We have demonstrated using histological staining that THBG decrease epidermis melanin content under unirradiated and irradiated condition. We also confirmed that THBG molecule is not a sunscreen agent. CONCLUSION: This study demonstrated that THBG controls skin tone via the inhibition of melanin synthesis as well as the modulation of skin brightness, yellowness, and redness.

Skin Care.

Aging skin is among the most common patient concerns in a facial plastic surgery practice. Ultraviolet (UV)-induced damage expedites the pace of intrinsic aging, resulting in many of the visible signs of aging, such as rough skin texture, pigmentation irregularities, fine and deep wrinkling, and inelasticity. Primary prevention of UV and environmental damage with proper skin care and the use of sunscreen are critical. There is great interest in topically applied products to reverse or delay the visible signs of photoaging. We discuss the most common topically applied agents for photoaging, reviewing their mechanisms and supporting evidence.

Signet-ring cutaneous squamous cell carcinoma arising on the back of the finger.

A variety of pathologic variants of cutaneous squamous cell carcinoma (SCC) has been reported, and the signet-ring variant of cutaneous SCC is extremely uncommon. We reported an 83-year-old man with signet-ring SCC arising on the back of the finger. As far as we know, only 4 cases have been described in detail, and one dermatopathologic report focused on the presence of signet-ring cells briefly described in clinical data of 6 cases. Interestingly, in these reports, the skin lesions of 10 cases occurred exclusively in the head and neck area. This case involved a skin lesion on the back of the finger and is thus the first reported case of signet-cell cutaneous SCC that did not arise in the head and neck area. The location of this lesion, together with the histological findings compatible with actinic keratosis, support the hypothesis that the development of signet-ring SCC is related to ultraviolet light-induced damage.

Dermatosis provocadas por la luz solar e influencia en la calidad de vida / Skin lesions caused by sunlight and their influence on quality of life

Introducción: en los últimos años ha existido un incremento de lesiones dermatológicas en las zonas expuestas al sol como resultado del deterioro de la capa de ozono, lo que se ha comportado según los distintos tipos de piel, ello ha determinado que los sujetos vean afectada su calidad de vida. Objetivos: determinar las afectaciones por daño solar según fototipo cutáneo y su relación con la calidad de vida en sujetos que trabajan en el mar.Métodos: estudio descriptivo en 204 sujetos trabajadores del mar mediante el examen clínico-dermatológico y una medición de su calidad de vida a través del Cuestionario General de Calidad de Vida, el que definió la afectación o no de esta. Resultados: predominaron los fototipos IV, V y III. La mayoría de los sujetos presentaron daño solar y afectaciones de la calidad de vida. Hubo relación significativa entre el fototipo cutáneo, el daño solar, la calidad de vida y el número de lesiones actínicas. Los diagnósticos más frecuentes fueron los léntigos y fotoenvejecimiento. Las dimensiones más afectadas fueron la salud física y la salud psicológica.Conclusiones: se encontró relación entre el fototipo cutáneo de los sujetos, daño solar y la calidad de vida(AU)

Introduction: "Recent years have witnessed an increase in the number of dermatological lesions on skin areas exposed to sunlight, as a result of the depletion of the ozone layer. Sun damage varies with skin type, and affects the subjects' quality of life. Objectives: determine sun-related skin damage by skin phototype and its relationship to quality of life in sea workers. Methods: descriptive study of 204 sea workers. All underwent clinical and dermatological examination as well as measurement of their quality of life through the General Quality of Life Questionnaire. Results: most subjects had sun-related skin damage and deterioration of their quality of life. Phototypes IV, V and III were predominant, and the most common diagnoses were lentigos and photoaging. The most affected areas were physical health and psychological health. Conclusions: sea workers show damage to their physical health due to their lengthy exposure to sunlight, which in turn affects their psychological health, particularly their self-esteem and mood. The combination of these factors negatively affects their quality of life and should be taken into account in the work strategies designed by their managers(AU)

Dermatosis provocadas por la luz solar e influencia en la calidad de vida / Skin lesions caused by sunlight and their influence on quality of life

En los últimos años ha existido un incremento de lesiones dermatológicas en las zonas expuestas al sol como resultado del deterioro de la capa de ozono, lo que se ha comportado según los distintos tipos de piel, ello ha determinado que los sujetos vean afectada su calidad de vida. Objetivos: determinar las afectaciones por daño solar según fototipo cutáneo y su relación con la calidad de vida en sujetos que trabajan en el mar. Métodos: estudio descriptivo en 204 sujetos trabajadores del mar mediante el examen clínico-dermatológico y una medición de su calidad de vida a través del Cuestionario General de Calidad de Vida, el que definió la afectación o no de esta. Resultados: predominaron los fototipos IV, V y III. La mayoría de los sujetos presentaron daño solar y afectaciones de la calidad de vida. Hubo relación significativa entre el fototipo cutáneo, el daño solar, la calidad de vida y el número de lesiones actínicas. Los diagnósticos más frecuentes fueron los léntigos y fotoenvejecimiento. Las dimensiones más afectadas fueron la salud física y la salud psicológica. Conclusiones: se encontró relación entre el fototipo cutáneo de los sujetos, daño solar y la calidad de vida...

"Recent years have witnessed an increase in the number of dermatological lesions on skin areas exposed to sunlight, as a result of the depletion of the ozone layer. Sun damage varies with skin type, and affects the subjects' quality of life. Objectives: determine sun-related skin damage by skin phototype and its relationship to quality of life in sea workers. Methods: descriptive study of 204 sea workers. All underwent clinical and dermatological examination as well as measurement of their quality of life through the General Quality of Life Questionnaire. Results: most subjects had sun-related skin damage and deterioration of their quality of life. Phototypes IV, V and III were predominant, and the most common diagnoses were lentigos and photoaging. The most affected areas were physical health and psychological health. Conclusions: sea workers show damage to their physical health due to their lengthy exposure to sunlight, which in turn affects their psychological health, particularly their self-esteem and mood. The combination of these factors negatively affects their quality of life and should be taken into account in the work strategies designed by their managers...

Câncer de pele e sua associação com dano solar / Skin cancer and its association with solar damage

Estima-se que o câncer de pele vem crescendo muito a cada ano, tanto por falta de informação a respeito do assunto quanto pela falta de conscientização da população. Os tipos histológicos mais frequentes do câncer de pele são: carcinoma basocelular (CBC), o tumor maligno cutâneo com maior incidência em indivíduos de pele clara carcinoma espinocelular (CEC), o sexto tipo mais comum de câncer em todo mundo e o melanoma, que é comum em populações brancas, em especial nos trópicos. A principal causa de câncer de pele é exposição à radiação ultravioleta (UV). A elastose solar é um indicador histológico de comprometimento cutâneo pela radiação solar. Objetivo: A presente pesquisa visa relacionar os tipos histológicos mais frequentes de câncer de pele e ocorrência de elastose solar. Material e métodos: Foi realizado um estudo retrospectivo, no período de 2005 a 2008, com levantamento 738 casos de cânceres de pele com diagnóstico de CBC, CEC e melanoma. Resultados: 539 casos eram de CBC, 174 eram de CEC e 25 eram melanomas. Em 47% dos casos os pacientes eram do sexo masculino e 53% eram femininos 67% estavam na faixa etária entre 60 e 80 anos. O ano de 2005 foi o que apresentou o menor número de casos de câncer de pele (157 casos) e o ano de 2008 apresentou a maior incidência (212 casos). Elastose solar esteve associada a 32% dos casos de câncer de pele, sendo mais frequente nos casos de CBC. Conclusões: A maior parte dos casos de câncer de pele não apresentou elastose solar associada, mostrando que não só a radiação solar influencia na gênese desses cânceres.

Two Cases of Multiple Cutaneous Squamous Cell Carcinomas / 대한피부과학회지

The causes of the cutaneous squamous cell carcinomas(SCCs) are diverse, and when the multiple SCCs are found at the same time, not only the treatment of the lesions but also the consideration of the causes are important. Then, when actinic keratoses coexist with SCCs on the sun-exposed area at the same time, the most probable cause of the SCC is the ultraviolet light-induced skin damage. But when the multiple SCCs are developed on the sun-protected area, one must consider the patient's history of exposure to arsenic. We report two patients having multiple SCCs of the skin. One is considered to be associated with the previous arsenic exposure and the other with chronic sun damage and the resultant actinic keratoses.