Incidence of Kaposi Sarcoma in Sweden is Decreasing.

Kaposi sarcoma is a rare skin cancer, and epidemiological research into Kaposi sarcoma is therefore scarce. The current epidemiological situation for Kaposi sarcoma in Sweden is unknown. The authors hypothesized that the incidence of Kaposi sarcoma should have decreased after the introduction of antiretroviral therapy in 1996. Using data from the Swedish Cancer Registry, this study aimed to determine the incidence rates and survival for Kaposi sarcoma in Sweden from 1993 to 2016. The results showed that a total of 657 patients (74.0% men, 26.0% women) were diagnosed with Kaposi sarcoma in Sweden during 1993 to 2016. The overall incidence per 100,000, age-standardized to the world population, decreased from 0.40 to 0.10 (p = 0.003) for both sexes combined, from 0.76 to 0.14 (p=0.003) for men, and from 0.07 to 0.06 (p = 0.86) for women. The 10-year overall survival rate was significantly lower for the study population (30%) compared with the age- and sex-matched Swedish population (56%) (p < 0.00001). Over the study period, incidence rates of Kaposi sarcoma decreased significantly in men, especially during the late 1990s.

Measurements of sun sensitivity in five European countries confirm the relative nature of Fitzpatrick skin phototype scale.

BACKGROUND/PURPOSE: Skin colour and sun sensitivity are highly related to the distance to the equator: people in southern latitudes are usually darker and less sensitive to sun than in northern latitudes. Whether differences in sun sensitivity can be found in a relatively homogenous European population is unclear. We aimed to objectively measure sun sensitivity (assessed as pigment protection factor (PPF)) in five European countries, relate it to self-assessed Fitzpatrick skin phototype (FST) and to determine whether PPF levels in the different FST categories are dependent on the investigated countries. METHODS: Volunteers (n = 569) were recruited in Copenhagen (Denmark), Dublin (Ireland), London (England), Münster (Germany) and Ioannina (Greece). Skin phototype was self-assessed using the FST scale. PPF was measured at both sun-protected buttocks and five sun-exposed skin sites by a skin reflectance spectrophotometer. RESULTS: Overall, there were statistically significant differences in PPF of the buttocks, inner arm, outer arm, forehead, chest and back between the five countries (P ≤ .031). Generally, PPF level was lower in northern than in southern latitudes. PPF of the buttocks was similar in all countries for those who identified as FST I (P = .723). However, it was statistically significantly different (P ≤ 2.913*10-4 ) and country-dependent for those who identified as FST II-IV. CONCLUSION: Objectively measured sun sensitivity is higher (lower PPF) in northern compared with southern latitudes. The choice of self-identified FST category is influenced by a person's immediate environment. Therefore, we confirmed the relative nature of the FST scale and the need to standardise the skin phototype assessment procedure.

Visual scales are superior to questionnaires in skin phototype self-assessment by children.

BACKGROUND/PURPOSE: There are no suitable methods for skin phototype self-assessment by children. Our study investigated several skin phototype self-assessment methods in children to identify the best correlation to objectively measure skin phototype. METHODS: Danish schoolchildren (ages 6-19) participated in a nation-wide study that assessed skin, eye, hair colour and sun behaviour. Skin phototype self-assessment was performed by children using two visual colour scales (cartoon faces and colour cards), question-based colour scale and questions about tendency to burn and ability to tan. For objective skin phototype measurements, 483 children from all age groups were selected and their pigment protection factor (PPF) was measured at three skin sites using a skin reflectance spectrophotometer. RESULTS: Cartoon faces (r2  = 0.654) and colour cards (r2  = 0.659) were better at predicting PPF on the inner forearm than the question-based colour method (r2  = 0.520). PPF prediction from questions on skin reaction to sun exposure was markedly inferior (r2  ≤ 0.142) to both visual colour scales and question-based colour method. CONCLUSION: Both visual colour scales proved to be superior to question-based skin phototype self-assessment in schoolchildren. In contrast, questions on skin reaction to sun exposure were shown to be an unsuitable tool for self-assessment of skin phototype in children.

Phototype reproducibility and relation to objectively measured skin sensitivity is best when burn and tan reactivity to sun are answered separately.

BACKGROUND/PURPOSE: Skin phototype questionnaires usually ask similar questions, but they differ in how the answers can be given. There is either one combined answer, which includes both tendency to burn and ability to tan, or 2 separate answers about burn and tan, respectively. We tested the reproducibility of different questionnaires and their relation to objectively measured skin phototype. METHOD: A total of 149 participants completed 3 skin phototype questionnaires distributed twice with median 3 months interval: (i) a Fitzpatrick questionnaire (FST-q) with combined answers about tendency to burn and ability to tan, (ii) a detailed questionnaire (Detail-q) with separate answers to 2 detailed questions about burn and tan and (iii) a short questionnaire (Short-q) with separate answers to 2 simplified questions about burn and tan. Objective skin phototype measurements were performed by measuring pigment protection factor (PPF) by spectrophotometry. RESULTS: Good-to-very-good reproducibility for all phototype questionnaires was shown by weighted kappa (κw ) values: κw  = .65 for the FST-q with combined (burn and tan) answers; κw  = .64 for tendency to burn and κw  = .68 for ability to tan for the Detail-q; and κw  = .72 for tendency to burn and κw  = .85 for ability to tan for the Short-q. PPF at all measurement sites was best predicted by the Detail-q (highest r2  = 0.285 on the outer arm), followed by the Short-q and by the FST-q. CONCLUSION: The detailed questionnaire with separate answers to 2 detailed questions about tendency to burn and ability to tan has good reproducibility, correlates best with objective skin measurements and is therefore the recommended method for determining skin phototype.

Protoporphyrin IX formation after application of methyl aminolevulinate on the face and scalp with and without prior curettage.

BACKGROUND: Pulse photodynamic therapy (PDT) is carried out as classical PDT except that methyl aminolaevulinate (MAL) is removed after 30 min. Protoporphyrin IX (PpIX) accumulation becomes lower after 3 h in pulse-PDT than in classical PDT, but pulse-PDT still has full treatment effect on actinic keratosis (AK). The present study aimed to investigate when PpIX formation in classical PDT without curettage reaches the PpIX level in pulse-PDT with curettage in the skin of the face and scalp. METHODS: Fourteen patients with AKs in the face and scalp were included in this pilot study. Each patient had two fields randomly allocated to two different regimes: (i) continuing MAL incubation without prior curettage (-Cur) and (ii) 30 min MAL incubation after curettage (+Cur). The PpIX level in each field was measured with a hand-held fluorescence photometer every 30 min for 6 h after MAL application. No illumination was performed. RESULTS: The median PpIX level in the +Cur field after 3 h was 22 arbitrary units (AU), which represents the amount of PpIX that could have been photobleached after pulse-PDT with maximal treatment effect. After 3 h the median PpIX level in the -Cur field was 20 AU, which was not significantly different from the level in the +Cur field (p = 0.9). CONCLUSIONS: We propose PDT without curettage as follows: 3 h of MAL incubation and subsequently sufficient illumination. The treatment effect of this regime should be tested to verify if curettage of the face and scalp area may be omitted in PDT.