Skin cancer prevention in extreme sports: Intervention in a 24-h race.

INTRODUCTION: Excessive sun exposure and sunburns are the main preventable causes of skin cancer. The growing popularity of outdoor sports in developed countries has motivated the objective of this work to study the risk of photoexposure and the skin cancer prevention needs of athletes in an extreme race and evaluate an intervention targeted at this population. METHODS: An observational study was conducted during the XXIII edition of the 101 km de Ronda race, which consisted of trail running and mountain biking categories. Environmental and personal dosimetry, monitoring of meteorological conditions, evaluation of the athletes' photoprotection and skin examination habits, a dermatological checkup, and a satisfaction questionnaire were performed. RESULTS: The ultra-endurance race was carried out under adverse conditions (maximum ultraviolet index (UVI) = 9.2, temperatures above 30°C, and relative humidity >35%). The mean effective erythema dose received by race athletes (n = 11) was 2959.2 ± 404.2 J/m2 , equivalent to 29.6 standard erythema doses (SED). The CHACES questionnaire (n = 1145) showed a sunburn rate of 58% and poor protective habits: 62.9% of athletes do not usually use sunscreen and 67.2% do not self-examine their skin. Actinic keratoses (4.7%) and suspicious skin cancer lesions (4.2%) were found in dermatologic screening exams (n = 170). On the satisfaction questionnaire (n = 111), this intervention was rated as excellent (95.5%). CONCLUSION: This research highlights the extreme risk of photoexposure that athletes are subjected to during ultra-endurance competitions. In the same way, it shows the need to carry out interventions aimed at the acquisition of healthy photoprotection habits and skin surveillance in this target group.

Ultraviolet sun exposure and sun protection behaviors in outdoor rock climbers.

BACKGROUND: Overexposure to sunlight and sunburn are the main preventable causes of skin cancer. Outdoor sports are associated with significant levels of sunlight exposure. AIMS: We sought to quantify the sun radiation exposure received by outdoor rock climbers and assess their sun exposure habits, sun protection behaviors, attitudes, and knowledge regarding skin cancer. METHODS: From April to June 2021, outdoor rock climbers contacted via email completed an online validated self-reported questionnaire on sun related habits, behaviors, attitudes and knowledge. As a pilot trial, ten participants wore a personal dosimeter during two outdoor climbing weekends in May and November 2021. Ambient ultraviolet radiation (UVR) was also recorded. RESULTS: A total of 217 outdoor rock climbers (103 women), mean age 36.8 ± 8.8 years (range 20-70 years) and median climbing practice per week of 8 h (IQR 7.5) were studied. Two in three (65.9%) participants reported at least one sunburn event during the previous rock climbing season. Of the survey respondents, 49.3% reported using sunscreen with SPF ≥ 15, 47% wore sunglasses, and 14.3% indicated they reapplied sunscreen every two hours. The median personal UVR dose measured during the two outdoor climbing weekends analyzed was 5.2 (IQR 1.8) and 8.8 (IQR 1.1) standard erythemal doses, respectively. CONCLUSIONS: The high rates of sunburn, the elevated personal UVR measured and the clearly insufficient sun protection practices followed during rock climbing together with unsatisfactory attitudes towards tanning reveal the need to develop explicit sun protection campaigns and educational strategies to reduce the risk of skin cancer among the athletes studied.

Occupational Sun Exposure Among Physical Education Teachers in Primary and Secondary Schools in Andalusia, Spain.

Chronic sun exposure and sunburns are the main preventable causes of skin cancer. Due to the nature of their work, physical education teachers are at high risk for occupational skin cancer. This descriptive, cross-sectional study analyzes primary and secondary physical education teachers in Andalusia, Spain. All participants were invited to monitor their ultraviolet (UV) radiation exposure using individual biologic dosimeters and record their photoprotection practices over 3 workdays. The teachers spent an average of 2.7 h outdoors and the mean personal UV radiation exposure was 309.9 J/m2 per day, a value three times higher than international recommendations. Based on the photoprotection diary, it was determined that classes held outdoors were not scheduled outside the hours with the highest UV index and that the percentage of participants who followed the photoprotective practices of remaining in the shade or wearing a hat during outdoor lessons were less than 20% and 60%, respectively. The results on sun exposure and photoprotection practices show a need for organizational and educational intervention strategies to mitigate sun exposure and increase compliance with photoprotection measures to reduce skin cancer risk among these workers and promote early diagnosis of the disease.

Sun Protection Policies and Practices in Preschool and Elementary Schools in Andalusia (Spain).

Sun exposure in childhood is a major risk factor for the development of skin cancer as an adult. School children spend much of their time outdoors exposed to ultraviolet radiation during recreational and sports activities. Skin cancer incidence tripled from 1978 to 2002 in Spain. Andalusia, the largest and sunniest region of Spain, lacks data on the sun protection measures taken in schools. To address this deficit, the aim of this study was to determine photoprotection practices and policies in preschools and primary schools in Andalusia. This descriptive study involved the administration of an online questionnaire completed by principals regarding school sun protection policies and practices. Preschool and primary schools were selected from the database of the Ministry of Education of the Andalusian Regional Government. Information of interest included photoprotection policies, students' sun protection knowledge, sun protection measures, relevant curricular content, and availability of shade at the school. A total of 2425 schools were contacted. Of them, 420 schools responded (17.31%), with the highest number of responses received from Malaga (23.8%) and Seville (19.5%) provinces. Of those responding, 67.1% of the schools did not have written sun protection policies. The photoprotection measures reported included mandatory use of a cap or hat (3.3%), use of sunglasses in outdoor areas (30%), and active encouragement of students to use sunscreen (50.7%). Roughly 24% of schools evaluated their shaded areas, with 52.9% reporting insufficient protection for most activities. The study results showed that photoprotection policies and practices in Andalusian schools were mostly insufficient. Given that skin cancer incidence has increased considerably over the last decade, it is important to concentrate on improving primary prevention practices. Additionally, photoprotection programs in schools have been shown to improve children's knowledge, attitudes, and habits regarding photoprotection. Thus, it is essential for Andalusian preschools and primary schools to develop policies and strategies to help reduce children's sun exposure while at school.

Quality of Life During Treatment for Cervicofacial Non-melanoma Skin Cancer.

Non-melanoma skin cancer (NMSC), despite its low mortality, can impose a significant psychological burden on patients. The aim of the present study is to examine the evolution of the quality of life (QOL) in patients with cervicofacial NMSC during treatment. This prospective cohort study was conducted to a group of patients with cervicofacial NMSC, confirmed by skin biopsy. These patients completed the Skin Cancer Index questionnaire at the time of diagnosis and at 1 week, 1 month and 6 months after treatment began. Data for these patients' demographic characteristics and variables related to the type of tumour, the treatment received and the evolution of the condition were recorded. The study group was composed of 220 patients. At the time of diagnosis, the overall mean score for QOL was 54.1 (SD 21.9); for the social appearance component, it was 76.7 (SD 26.2), and for the emotional component, it was 23 (SD 25.1). Six months after treatment began, the overall mean score was 61 (SD19.1), that for social appearance, 85 (SD 20.6), and that for the emotional component, 27.4 (SD 26.6). All the differences were statistically significant (p < 0.05). The results obtained show that during the treatment period, it is at the time of diagnosis when patients with cervicofacial NMSC undergo the greatest deterioration in their QOL. In comparison with the findings obtained in previous studies, our population obtained lower overall scores in the questionnaires and less improvement during follow-up.

Sun Protection Behaviour and Sunburns in Spanish Cyclists.

Sunburn caused by overexposure to ultraviolet radiation is the main cause of preventable skin cancer. This study aimed to describe the sun protection habits and rate of sunburns associated with the practice of cycling and to identify predictive factors of sunburn among cyclists. A descriptive observational study based on online surveys was conducted. Recruitment of participants was conducted through the Andalusian Cycling Federation (Spain). A questionnaire on behaviour, attitudes, and knowledge related to sun exposure was used. A bivariate analysis was carried out with sunburn episodes during the previous year as outcome variable, and a multivariate logistic regression model was built. Of the 1018 surveys returned, 87.6% were answered by men, mean age was 41.8 years (SD: 11.0), and 37.6% of the participants had phototype I or II. Sunburns during the previous year were reported by 45.6% (95% CI: 42.5-48.7) of the respondents. Sunscreen use was reported by 39.2%, and 61.0% did not examine their skin regularly despite the fact that 34 subjects (3.4%) reported a personal history of skin cancer. The multivariate logistic regression analysis showed that there was a negative correlation between episodes of sunburn and age, phototypes I-II, more than 2 h of sun exposure, and inconsistent use of sunscreen. Cyclists have high rates of sunburns and thus constitute a high-risk group for developing skin cancer. Educational interventions specifically aimed at this group of athletes would improve sun protection knowledge and practices, particularly the use of sunscreen.

A facility and community-based assessment of scabies in rural Malawi.

BACKGROUND: Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. METHODOLOGY/PRINCIPAL FINDINGS: From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. CONCLUSIONS/SIGNIFICANCE: Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control.

Factors related to the evolution of quality of life in patients with cervicofacial non-melanoma skin cancer.

PURPOSE: Non-melanoma skin cancer (NMSC) is the most frequent neoplasm today, worldwide. This type of tumour presents low mortality but causes a major psychosocial impact on the patient. Studies have shown that the patient's quality of life (as detected by questionnaire scores in this respect) improves as the care process advances. The main aim of the present study is to identify the factors that are related to this favourable evolution. METHODS: This descriptive cross-sectional study included patients with cervicofacial NMSC, confirmed by skin biopsy. The patients were asked to complete the Skin Cancer Index questionnaire at the time of diagnosis and subsequently at 1 week, 1 month and 6 months after treatment. Relevant demographic variables were recorded, together with information on health status and the treatment received. RESULTS: A total of 229 patients with biopsy-confirmed cervicofacial NMSC were included in the study population, and 220 completed the quality of life questionnaires at the necessary time points during the care process. Some variables-sex, education, marital status, history of anxiety or depression, tumour type, the treatment received and the VAS score in this respect-were found to have a statistically significant influence on the degree of improvement recorded in the quality of life questionnaire scores during follow-up. CONCLUSIONS: The quality of life questionnaire scores of patients with cervicofacial NMSC improve following treatment, but this progression is not homogeneous among patients. We identify the variables that are related to a greater degree of improvement on the questionnaire scales (overall, emotional and social-aesthetic).

Assessment of Quality of Life Following Diagnosis in Patients with Cervicofacial Non-melanoma Skin Cancer.

Non-melanoma skin cancer (NMSC) is the most common neoplasm. The characteristics of this disease (location in aesthetically sensitive areas, the appearance of successive tumors during follow-up, and high rates of survival) are such that the concept of health-related quality of life (HRQoL) is of particular importance. The aim of the present study was to describe and analyses patient quality of life following diagnosis with cervicofacial NMSC. A descriptive cross-sectional study was conducted on patients with cervicofacial NMSC, confirmed by skin biopsy. In each case, when the definitive diagnosis of NMSC was established, the patient completed the Skin Cancer Index questionnaire and demographic data, health status, and sun exposure habits were recorded. The study population was composed of 220 patients with histologically confirmed cervicofacial NMSC. The mean score obtained for the Skin Cancer Index questionnaire was 54.1 (SD 21.9), in which the social-aesthetic component had a mean score of 76.7 (SD 26.2), while the emotional component had a mean score of 23 (SD 25.1). Male patients, those with secondary or higher education, and those who had no history of anxiety or depression had significantly higher mean scores for HRQoL. This study demonstrated that the diagnosis of cervicofacial NMSC significantly impacts HRQoL and that certain population groups (women, persons with only primary or no education qualifications, and those a history of anxiety or depression) are more susceptible. The questionnaire scores obtained were lower than those reported in previous studies on this topic and reflect a particularly strong impact on emotional aspects of patient quality of life.

Prevalence and predictors of sunburn among beachgoers.

BACKGROUND: Painful sunburns at any age are one of the main risk factors for skin cancer. OBJECTIVES: To determine the prevalence and predictors of sunburn among beachgoers. METHODS: A cross-sectional health survey was conducted at the beach during the summer. Adults >18 years with an understanding of Spanish were interviewed using a questionnaire about behaviours, attitudes and knowledge related to sun exposure at the beach. A descriptive analysis was performed, and a log-binomial regression model was used to determine predictors of sunburn. RESULTS: The survey was completed by 1054 beachgoers, with a mean age of 43.8 (SD: 18.7) years, 61.2% women, skin phototypes i (13.6%), ii (22.3%), iii (34.0%) and iv (30.2%). 46.9% of responders reported at least one painful sunburn during the previous summer. Age, sex, education, skin phototype, midday sun exposure, sun protection habits, attitudes towards tanning and knowledge about skin cancer were identified as independent predictors of sunburn. CONCLUSIONS: It is necessary to develop photoprotection campaigns aimed at beachgoers, particularly in young people, men, those with skin phototypes I-III and secondary or university education. Educational strategies should be aimed at discouraging sun exposure at midday, changing attitudes towards tanning and improving knowledge about skin cancer.

Sun Protection Habits and Attitudes Among Healthcare Personnel in a Mediterranean Population.

Health professionals are key agents in healthcare promotion. In the field of skin cancer, they play a crucial role in the development of prevention strategies in the community. This paper aims to describe the sun exposure attitudes and habits of public healthcare professionals in the western Costa del Sol (Spain). A cross-sectional descriptive study was conducted in the Costa del Sol healthcare district to analyse sun exposure and protection practices and habits, and attitudes to tanning and sun protection. The respondents, all healthcare personnel in various professional categories and workplace situations, were asked to complete a self-administered questionnaire. Six hundred forty-three workers in the Costa del Sol healthcare district took part in the study. Of these participants, 450 were healthcare professionals. Of the 450 health professionals, 226 (50.2 %) were nurses or auxiliary nursing staff, and the remaining 224 were doctors. These two groups presented differences regarding habits of sun exposure: 15.3 % of the doctors went to the beach at least 30 days a year, compared to 30.9 % of the nurses (p < 0.001). With respect to workplace situation, there were differences (p < 0.001) between the sunburn events reported by healthcare staff who worked in hospitals (52.4 %) compared to those working in primary healthcare (30.4 %); comparable differences were found with respect to attitudes toward the use of sunscreen creams (p = 0.014). This study identifies two distinct subgroups within healthcare personnel: on one hand, primary healthcare professionals, who are key agents for future policy strategies, and on the other, specialist healthcare professionals, who are more likely to suffer sunburn events and therefore toward whom strategies should be addressed to encourage them to change their sun exposure attitudes and habits and sun protection practices.

Pilomatrix carcinoma with lymph node and pulmonary metastasis: report of a case arising on the knee.

A 58-year-old woman presented with a pilomatrix carcinoma on the right knee. The tumor developed at the site of a previous lesion that had been present since she was 30 years old. Histologic study showed the presence of basaloid cells with numerous atypical mitoses, shadow cells, and calcification. After several surgical excisions, the tumor mass infiltrated the subcutaneous tissue, muscle, and bone, resulting in inguinal lymph node and pulmonary metastasis. We also review the literature and comment on the histopathologic differences from other cutaneous tumors.