Patient Perception of Skin Cancer Reduction by Nicotinamide Correlates With Use.

Introduction Nicotinamide (Vitamin B3) has been shown to reduce the rate of non-melanoma skin cancers by 23%, yet most patients do not know that this supplement reduces skin cancer. Understanding patient beliefs about skin cancer reduction attributed to nicotinamide is important to appropriately counsel patients on oral supplement use and ultimately to prevent non-melanoma skin cancers. Objective The objective of this study was to determine the association between nicotinamide use and perceived efficacy in skin cancer reduction. Methods Patients who underwent Mohs surgery in 2019 were sent an online survey assessing nicotinamide use, efficacy compared to sunscreen, and perceived skin cancer risk reduction. Results Data from 50 surveys revealed a perceived risk reduction attributed to nicotinamide of 31.2% for basal cell carcinoma (BCC), 30.2% for squamous cell carcinoma (SCC), and 24.3% for melanoma. In the subset of respondents taking nicotinamide, the perceived risk reduction was significantly higher at 41.2% for BCC and 38.3% for SCC (p<0.05) and positively correlated with reported nicotinamide use (p<0.05). The perceived risk reduction of melanoma was not significantly increased in patients taking nicotinamide (31.6%); however, the perceived risk reduction was correlated with nicotinamide use (p<0.05). In addition, 15.6% of respondents believed that nicotinamide was more effective than sunscreen at preventing skin cancer. Conclusion A larger perceived reduction of non-melanoma skin cancers attributed to nicotinamide is associated with increased oral nicotinamide use. Better patient education regarding the reduction of skin cancers with oral nicotinamide will need to be implemented to change patients' perceptions of the value of nicotinamide.

Non-Invasive Diagnosis of Sun Damaged Skin: Actinic Keratosis Vs Squamous Cell Carcinoma.

IMPORTANCE: Actinic keratosis (AK) is a premalignant lesion that has a1% to 10% potential of progression to squamous cell carcinoma (SCC), but it is not possible to determine which lesions are at higher risk. OBJECTIVE: This study examined the epidermal genetic profiles of actinic keratosis and SCC through non-invasive techniques seeking to develop a biopsy-free method for AK monitoring and aid in the early diagnosis of developing SCC. DESIGN: Ribonucleic acid (RNA) was collected from adhesive tape strips and gene expression levels were measured. A threshold fold change >2 and adjusted P-value <0.05 were used to determine differentially expressed genes. SETTING: Single center dermatology clinic. PARTICIPANTS: Patients who presented to the clinic with lesions suspicious of non-melanoma skin cancer that had never been previously biopsied. MAIN OUTCOME AND MEASURE: RNA was extracted via non-invasive biopsy and sequenced. Low quality samples were filtered out and the remaining samples underwent differential gene expression analysis by DESeq2 in R package. A threshold of fold change >2 and adjusted P-value <0.05 was used for determination of differentially expressed genes. The differentially expressed genes that overlapped between the corrected and uncorrected groups were the most significant for analysis. RESULTS: From 47 lesions, 6 significant differentially expressed genes were found between AK and SCC, and 25 significant differentially expressed genes between in-situ SCC and invasive SCC. Individual samples showed similarities based on diagnosis, suggesting mutations were specific to the disease and not the individual. CONCLUSIONS AND RELEVANCE: These findings highlight which genes may play a role in AK progression to SCC. The genomic differences between in-situ and invasive squamous cell carcinoma open an opportunity for early diagnosis of squamous cell carcinoma and risk prediction of actinic keratosis. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7097.

Ultraviolet B-Rays Induced Gene Alterations and DNA Repair Enzymes in Skin Tissue.

BACKGROUND: Ultraviolet (UV) radiation leads to deoxyribonucleic acid (DNA) damage and changes in gene expression. Topical DNA repair enzymes in liposomes are capable of undoing this damage. OBJECTIVE: To evaluate gene expression changes induced by ultraviolent B-rays (UVB) light and assess the effect of topical DNA repair enzymes extracted from Micrococcus luteus (M. luteus) and photolyase in modifying these changes. METHODS: Non-invasive, adhesive patch collection kits were used to sample skin on the right and left post-auricular areas before and 24 hours after UVB exposure (n=48). Subjects applied topical DNA repair enzymes to the right post-auricular area daily for 2 weeks. Subjects returned 2 weeks later for repeat non-invasive skin sample collection. RESULTS: Eight of 18 tested genes demonstrated significant changes 24 hours following UVB exposure. DNA repair enzymes from M. luteus or photolyase had no significant effect on genetic expression compared with the control at 2 weeks post UV exposure. CONCLUSION: UVB exposure causes acute changes in gene expression, which may play roles in photo-aging damage and skin cancer growth and regulation. While non-invasive gene expression testing can detect UV damage, additional genomic studies investigating recovery from UV damage at different time periods are needed to establish the potential of DNA repair enzymes to minimize or reverse this damage. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7070.

Artificial Intelligence in the Evaluation of Telemedicine Dermatology Patients.

BACKGROUND: Background: Early detection of malignant skin lesions reduces morbidity. There is increased need for a telemedicine triage tool to prioritize patients who require in-person evaluation for potential malignancy. OBJECTIVE: To evaluate the utility of artificial intelligence (AI) in telemedicine triage and diagnosis of cutaneous lesions. METHODS: Clinical photographs of unbiopsied skin lesions were presented to AI software and three board-certified dermatologists with 18 years average clinical experience. Diagnoses were compared with biopsy reports of the same lesions. RESULTS: Results from 100 images revealed no significant diagnostic difference between AI and a panel of three dermatologists when using the AI top three differential diagnoses. The AI correctly identified 63% of the cases whereas the dermatology group correctly identified 64.3% of the cases (P<.05). In summary, there was no statistically significant difference when evaluating lesions. CONCLUSION: The use of artificial intelligence as a method of triaging patients with potential skin cancer is a very useful option in telemedicine, as AI identification of BCC, SCC, and melanoma did not significantly differ from board-certified dermatologists. Both dermatologists and non-dermatologists will benefit from an AI triage system, prioritizing lesions that the software deems malignant. J Drugs Dermatol. 2022;21(2):191-194. doi:10.36849/JDD.6277.

Skin Cancer in the Incarcerated Population-A Single-Center Study.

BACKGROUND: The incarcerated population may have variable access to specialty care that may affect the detection and diagnosis of skin cancer. OBJECTIVE: The purpose of the study was to characterize skin cancers in the incarcerated population and determine time to treatment initiation (TTI) after biopsy. METHODS: A retrospective cohort study was performed using data from a single-center referral hospital of incarcerated patients with biopsy-proven basal cell carcinoma (BCC), squamous cell carcinoma (SCC), or melanoma between January 2009 and December 2019. The main outcome measured was TTI after biopsy. RESULTS: One hundred thirteen patients, majority men (96.5%) and of Caucasian race (89.4%), were diagnosed and/or treated for 191 skin cancers. Of these 191 skin cancers, 118 were BCC (61.8%), 58 were SCC (30.4%), and 15 were melanomas (7.9%). The average TTI after biopsy for melanoma was 57 days (range: 21-136, median: 51, 95% confidence interval: 39.89-74.10) with an average Breslow depth of 1.57 mm. CONCLUSION: The average TTI of melanoma in the incarcerated population in this study was greater than 30 days, which may have increased mortality risk.

Management of skin thinning and aging: review of therapies for neocollagenesis; hormones and energy devices.

BACKGROUND: Hormone replacement therapy and various devices exist to treat signs of aging, such as skin thinning, yet there are no reviews summarizing or evaluating their role in neocollagenesis and the associated increase in skin thickness. OBJECTIVE: To review the literature regarding stimulation and generation of new collagen in the dermis in two parts. Part 2 reviews oral and topical hormone replacement therapy as well as energy-based devices. METHODS: The PubMed database was searched for related literature. Studies involving the use of hormone supplements and energy devices with a resultant change in collagen production or skin thickness were obtained and reviewed for evidence. RESULTS: Hormones, including estrogen, testosterone, and dehydroepiandrosterone, and human growth hormone have been reported with substantiating evidence for neocollagenesis and dermal thickening. Energy devices, including radiofrequency, ultrasound, and laser therapy, have also been reported to stimulate neocollagenesis. LIMITATIONS: The results presented in certain literature are not based on randomized controlled trials. CONCLUSION: Hormone deficient individuals can regain skin thickness with hormone replacement therapy. Dermal heating can provide a substantial amount of neocollagenesis; however, laser technology, specifically CO2 , appears to be the most effective at increasing skin collagen and tightening.