Translation and Validation of the Dutch Version of the Sun Exposure and Protection Index.

INTRODUCTION: Skin cancer is currently the most common cancer type worldwide, and numbers are rapidly increasing. To improve primary prevention, individualised prevention strategies may be of interest as this enhances the chance of long-term behavioural change. The Sun Exposure and Protection Index (SEPI), previously validated in multiple languages, is a tool that could help identify individuals with risky behaviour and tailor interventions to the person's propensity to change. The aim of the present study was to investigate the reliability and validity of a Dutch version of the SEPI for both usage in daily clinical practice and research. METHODS: Patients were included at primary care settings and dermatology outpatient settings in a 1:1 ratio. Participants were asked to fill out the SEPI together with some baseline characteristics and the previously validated FACE-Q Skin Cancer - Sun Protection module. Construct validity was tested by comparing SEPI part I and the FACE-Q module using Spearman's Rho. Internal consistency was assessed with Cronbach's Alpha for both SEPI parts separately. To assess test-retest reliability, the SEPI was again filled out 3 weeks later, and scores were compared with Cohen's weighted Kappa. RESULTS: Of the 171 participants completing the first questionnaire, 147 (86.0%) participants also completed the follow-up questionnaire. Comparison between the corresponding SEPI part I and FACE-Q module questions showed good correlations regarding sun exposure habits (correlation coefficients ranging from 0.61 to 0.85). Internal consistency of SEPI part I was 0.63 and SEPI part II was 0.65. The test-retest analysis indicated reproducibility over time (weighted Kappa ranging from 0.38 to 0.76). CONCLUSION: In conclusion, the Dutch version of the SEPI is shown to be a valid and reliable tool for both usages in daily clinical practice and research to evaluate individual ultraviolet exposure and measure a person's propensity to limit it.

Sunscreens With High Versus Low Sun Protection Factor and Cutaneous Squamous Cell Carcinoma Risk: A Population-Based Cohort Study.

Evidence on sunscreen use and cutaneous squamous cell carcinoma (cSCC) risk is limited. Most studies have not taken sun protection factor (SPF) into consideration and used nonusers of sunscreen as the reference group. Nonusers are likely a priori at lower cSCC risk than users. No study has investigated the effect of high- versus low-SPF sunscreens on cSCC, appropriately adjusting for time-varying confounding. Using data from the Norwegian Women and Cancer Study (1991-2016), we investigated whether use of SPF ≥15 versus SPF <15 sunscreens reduces cSCC risk. We used a marginal structural Cox proportional hazards model with inverse probability of treatment and censoring weights to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During follow-up of 148,781 women (mean follow-up, 14.3 years), 653 women were diagnosed with cSCC. The effect on cSCC risk of sunscreens with SPF ≥15 versus SPF <15 was close to the null when used at any latitudes (HR = 1.02, 95% CI: 0.82, 1.27) and when used in lower-latitude settings (HR = 1.05, 95% CI: 0.84, 1.32). In conclusion, we found no indication that sunscreens with SPF ≥15 reduced Norwegian women's cSCC risk more than sunscreens with SPF <15, suggesting that either there is no difference in their effects long-term or the difference is diluted by incorrect application.

Assessment of sun-safety education behavior via spectrophotometric evaluation: A preliminary study.

BACKGROUND: Biases inherent in self-assessment of sun exposure and sun-safe behavior may lead to inaccurate conclusions about the effectiveness of sun-safety educational programs. OBJECTIVES: We aimed to compare self-reports to objective measures of sun exposure, when examining the effectiveness of passive versus active educational interventions. METHODS: From May to June 2018, 73 participants recruited at a dermatology clinic were sequentially assigned to receive sun-safety education through one of 3 modes: interactive online module, video, or no education. A baseline Sun Exposure and Behavior Inventory (SEBI) questionnaire was administered, and spectrophotometric measurements of sun-exposed and sun-protected areas were taken and reported in the CIE L*a*b* color space. Participants were followed 4-8 and 16 weeks after the initial visit where the SEBI was re-administered, and serial measurements of skin color were taken. The change in SEBI scores and L*a*b values, as calculated by the individual typology angle (ITA°), was analyzed. RESULTS: There was a significant increase in skin darkening in all the groups at 4-8 and 16 weeks follow-up. There was no statistically significant difference between the groups in the magnitude of color change. However, subjectively at 4-8 weeks post-intervention, participants in the interactive module and video groups had significantly improved self-reported SEBI scores compared to control (p < .05, Kruskal-Wallis). By 16 weeks, only the interactive module group showed significant improvement in SEBI scores compared to control (p < .05, ANOVA). CONCLUSION: In determining the effectiveness of sun-safety programs, spectrophotometric evaluation of sun-induced skin pigmentation can allow for a more complete evaluation of self-reported sun exposure and sun-protective behavior.

Evidence concerning the accusation that melanoma is overdiagnosed.

BACKGROUND: Melanoma is one of the most commonly diagnosed malignancies in the United States and is responsible for the majority of deaths from skin cancer. OBJECTIVE: Since the 1970s, the incidence of melanoma has risen appreciably while melanoma-specific mortality has remained stable. This has raised a debate about potential overdiagnosis of melanoma. Herein, we review temporal trends in melanoma incidence and mortality and explore factors that may contribute to observed trends, including an aging population in the United States, ultraviolet exposure, increased numbers of biopsies by dermatologists and physician extenders, skin cancer screenings, histopathology criteria, and historic underdiagnosis. Additionally, we discuss melanoma overdiagnosis and the extent to which it may contribute to current trends. METHODS: The literature was reviewed. RESULTS: Several factors may contribute to an increased incidence of melanoma, including an aging population, ultraviolet exposure, increased skin biopsies, skin cancer screenings, histopathologic criteria, historic underdiagnosis, and current overdiagnosis. LIMITATIONS: Further studies are required to determine exactly which tumors are being overdiagnosed, and how to improve patient outcomes with adjustment to physician's practice. CONCLUSION: The rise in the incidence of melanoma observed since the 1970s is likely multifactorial.

Ultraviolet radiation and risk of cutaneous melanoma and squamous cell carcinoma in males and females in the Norwegian Offshore Petroleum Workers cohort.

BACKGROUND: Increased risk of cutaneous melanoma and squamous cell carcinoma (SCC) has been reported among petroleum workers, but few studies include females, exposure data on ultraviolet radiation (UVR), and potential confounding factors. We aimed to examine UVR exposure in relation to risk of melanoma and SCC among male and female offshore petroleum workers. We also examined the association between UVR exposure and melanoma (Breslow) thickness. METHODS: The Norwegian Offshore Petroleum Workers (NOPW) cohort (n = 27,917) holds information on sunbathing, indoor tanning, sunburns, sunscreen use, and other lifestyle factors recorded in 1998. Linkage to the Cancer Registry of Norway gave information on cancer diagnosis through 2017. We used Cox and logistic regression to estimate hazard ratios (HRs) of skin cancer and odds ratios (OR) of thick (≥1 mm) melanomas, respectively, with 95% confidence intervals (CIs). RESULTS: Melanoma risk increased with increasing frequency of sunbathing after age 20 (ptrend = 0.031), sunburn average intensity (ptrend = 0.028), and sunscreen use (HR = 2.16; 95% CI: 1.42 -3.27 for almost always vs. never/rarely). The risk of thick melanoma was inversely associated with sunbathing frequency after age 20 (OR = 0.38; 95% CI: 0.16 - 0.90 for ≥4 weeks/year vs. 1 week/year). SCC risk increased with increasing frequency of indoor tanning after age 20 (HR = 2.72; 95% CI: 1.22 - 6.05 for ≥3 times/months vs. never), sunburn average intensity (ptrend < 0.001), and sunscreen use (ptrend < 0.001). CONCLUSIONS: Our results support associations between UVR exposure and skin cancer risk in male and female offshore petroleum workers. This occupational group may be especially relevant for targeted sun protection advice.

Sun Exposure and Protection Index (SEPI) and Self-Estimated Sun Sensitivity.

The incidence of skin cancer is increasing worldwide, mostly because of increasing exposure to ultraviolet (UV) radiation from the sun. The Sun Exposure and Protection Index (SEPI) questionnaire, developed in Linköping and validated in Sweden and Australia, is used to map sun habits, sun protection behaviour, and readiness to increase sun protection. We sought to examine differences in sun habits or sun protection behaviour and propensity to increase sun protection, based on SEPI as related to self-estimated skin UV sensitivity according to the Fitzpatrick classification. The study population comprised students at Linköping University, who were asked to complete the SEPI questionnaire. We examined differences in sun habits and sun protection behaviour according to skin type and gender. Individuals with lower UV sensitivity had significantly riskier sun habits and sun protection behaviour and were significantly less likely to increase sun protection. Women spent significantly more time tanning than men, more time in the midday sun, used sunscreen more frequently, and were more likely to seek the shade for sun protection. Individuals with higher UV sensitivity were significantly more likely to increase sun protection; individuals with low UV sensitivity tended to have a riskier attitude to sunbathing. In conclusion, self-estimated skin type and gender are important factors influencing sun exposure habits and sun protection behaviour.

Solar UV exposure among outdoor workers in Denmark measured with personal UV-B dosimeters: technical and practical feasibility.

BACKGROUND: Exposure to solar ultraviolet radiation is a well-known cause of skin cancer. This is problematic for outdoor workers. In Denmark alone, occupational skin cancer poses a significant health and safety risk for around 400,000 outdoor workers. Objective measures of solar ultraviolet radiation exposure are needed to help resolve this problem. This can be done using personal ultraviolet radiation dosimeters. METHODS: We consider technical and practical feasibility of measuring individual solar ultraviolet exposure at work and leisure in professions with different á priori temporal high-level outdoor worktime, using aluminium gallium nitride (AlGaN) photodiode detector based personal UV-B dosimeters. Essential technical specifications including the spectral and angular responsivity of the dosimeters are described and pre-campaign dosimeter calibration applicability is verified. The scale and conduct of dosimeter deployment and campaign in-field measurements including failures and shortcomings affecting overall data collection are presented. RESULTS: Nationwide measurements for more than three hundred and fifty workers from several different professions were collected in the summer of 2016. On average, each worker's exposure was measured for a 2-week period, which included both work and leisure. Data samples of exposure at work during a Midsummer day show differences across professions. A construction worker received high-level occupational UV exposure most of the working day, except during lunch hour, accumulating to 5.1 SED. A postal service worker was exposed intermittently around noon and in the afternoon, preceded by no exposure forenoon when packing mail, accumulating to 1.6 SED. A crane fitter was exposed only during lunch hour, accumulating to 0.7 SED. These findings are in line with our specialist knowledge as occupational physicians. CONCLUSIONS: Large-scale use of personal UV-B dosimeters for measurement of solar ultraviolet radiation exposure at work and leisure in Denmark is indeed feasible from a technical and practical viewpoint. Samples of exposure data shown support the presumption that the Danish campaign UV-B dosimeter measurement dataset can be used to sum and compare exposure between groups of professions with reliable results to be used in future analysis with clinical as well as epidemiological/questionnaire data. This was despite some dosimeter failures and shortcomings.

Sunburn and sun-protective behaviors among adults with and without previous nonmelanoma skin cancer (NMSC): A population-based study.

BACKGROUND: Individuals with previous nonmelanoma skin cancer (NMSC) are at increased risk for subsequent skin cancer, and should therefore limit ultraviolet exposure. OBJECTIVE: We sought to determine whether individuals with previous NMSC engage in better sun protection than those with no skin cancer history. METHODS: We pooled self-reported data (2005 and 2010 National Health Interview Surveys) from US non-Hispanic white adults (758 with and 34,161 without previous NMSC). We calculated adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI), taking into account the complex survey design. RESULTS: Individuals with previous NMSC versus no history of NMSC had higher rates of frequent use of shade (44.3% vs 27.0%; aPOR 1.41; 95% CI 1.16-1.71), long sleeves (20.5% vs 7.7%; aPOR 1.55; 95% CI 1.21-1.98), a wide-brimmed hat (26.1% vs 10.5%; aPOR 1.52; 95% CI 1.24-1.87), and sunscreen (53.7% vs 33.1%; aPOR 2.11; 95% CI 1.73-2.59), but did not have significantly lower odds of recent sunburn (29.7% vs 40.7%; aPOR 0.95; 95% CI 0.77-1.17). Among those with previous NMSC, recent sunburn was inversely associated with age, sun avoidance, and shade but not sunscreen. LIMITATIONS: Self-reported cross-sectional data and unavailable information quantifying regular sun exposure are limitations. CONCLUSION: Physicians should emphasize sunburn prevention when counseling patients with previous NMSC, especially younger adults, focusing on shade and sun avoidance over sunscreen.

[Most common skin disorders caused by excessive exposure to sunlight]. / Napsugárzás által okozott leggyakoribb borártalmak.

The healing properties of sunlight has been known for millennia, however the gradual deterioration of the ozone layer and the increased use of sun tanning beds in recent decades are causing an increase in skin damaging ultraviolet exposure. In this article the most common photodermatoses and the principles of their treatments are reviewed.

UV radiation induces CXCL5 expression in human skin.

CXCL5 has recently been identified as a mediator of UVB-induced pain in rodents. To compare and to extend previous knowledge of cutaneous CXCL5 regulation, we performed a comprehensive study on the effects of UV radiation on CXCL5 regulation in human skin. Our results show a dose-dependent increase in CXCL5 protein in human skin after UV radiation. CXCL5 can be released by different cell types in the skin. We presumed that, in addition to immune cells, non-immune skin cells also contribute to UV-induced increase in CXCL5 protein. Analysis of monocultured dermal fibroblasts and keratinocytes revealed that only fibroblasts but not keratinocytes displayed up regulated CXCL5 levels after UV stimulation. Whereas UV treatment of human skin equivalents, induced epidermal CXCL5 mRNA and protein expression. Up regulation of epidermal CXCL5 was independent of keratinocyte differentiation and keratinocyte-keratinocyte interactions in epidermal layers. Our findings provide first evidence on the release of CXCL5 in UV-radiated human skin and the essential role of fibroblast-keratinocyte interaction in the regulation of epidermal CXCL5.

A randomized trial of a wearable UV dosimeter for skin cancer prevention.

Background: Non-melanoma skin cancer (NMSC) is the most prevalent cancer in the United States. Despite guidelines on ultraviolet (UV) avoidance, it remains difficult for people to assess their exposure, as UV is invisible and the onset of UV-induced symptoms is delayed. Methods: In a prospective randomized trial, 97 elderly patients with a history of actinic keratoses (AK) were followed over 6 months. Fifty patients received UV counseling from a dermatologist and a wearable UV dosimeter that provided real-time and cumulative UV exposure. Forty-seven patients received only UV counseling from a dermatologist. Results: Over 75% of participants recorded UV exposure at least once a week during the summer. After 6 months of intervention, when comparing the device group to the control group, we observed a non-significant 20% lower ratio of incidence rates of AKs (95% CI = [-41, 55%], p-value = 0.44) and a significant 95% lower ratio of incidence rates of NMSCs (95% CI = [33, 99.6%], p-value = 0.024). Surveys demonstrated that the control group's score in self-perceived ability to participate in social activities significantly increased by 1.2 (p-value = 0.04), while in the device group, this score non-significantly decreased by 0.9 (p-value = 0.1). We did not observe changes, or between-group differences, in anxiety and depression surveys. Conclusion: This pilot clinical trial has a short duration and a small sample size. However, device adherence and quality of life questionnaires suggest a smartphone-connected wearable UV dosimeter is well accepted by an elderly population. This trial also indicates that a wearable UV dosimeter may be an effective behavioral change tool to reduce NMSC incidence in an elderly population with a prior history of AKs.Clinical trial registration: clinicaltrials.gov, identifier NCT03315286.

Sesamin attenuates UVA-induced keratinocyte injury via inhibiting ASK-1-JNK/p38 MAPK pathways.

BACKGROUND: Ultraviolet (UV) exposure-stimulated reactive oxygen species (ROS) formation in keratinocytes is a crucial factor in skin aging. Phytochemicals have become widely popular for protecting the skin from UV-induced cell injury. Sesamin (SSM) has been shown to play a role in extensive pharmacological activity and exhibit photoprotective effects. AIM: To assess the protective effect of SSM on UVA-irradiated keratinocytes and determine its potential antiphotoaging effect. METHODS: HaCaT keratinocytes pretreated with SSM were exposed to UVA radiation at 8 J/cm2 for 10 min. Cell viability and oxidative stress indicators were evaluated using a cell counting kit-8 and lactate dehydrogenase (LDH), malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) assay kits. Apoptosis and intracellular ROS levels were analyzed using annexin V-fluorescein isothiocyanate/propyridine iodide and dichlorodihydrofluorescein diacetate staining, respectively. Protein levels of matrix metalloprotein-1 (MMP-1), MMP-9, Bax/Bcl-2, and mitogen-activated protein kinase (MAPK) pathway proteins, phospho-apoptosis signal-regulating kinase-1 (p-ASK-1)/ASK-1, phospho-c-Jun N-terminal protein kinase (p-JNK)/JNK, and p-p38/p38 were determined using western blotting. RESULTS: Sesamin showed no cytotoxicity until 160 µmol/L on human keratinocytes. Sesamin pretreatment (20 and 40 µM) reversed the suppressed cell viability, increased LDH release and MDA content, decreased cellular antioxidants GSH and SOD, and elevated intracellular ROS levels, which were induced by UVA irradiation. Additionally, SSM inhibited the expression of Bax, MMP-1, and MMP-9 and stimulated Bcl-2 expression. In terms of the regulatory mechanisms, we demonstrated that SSM inhibits the phosphorylation of ASK-1, JNK, and p38. CONCLUSION: The results suggest that SSM attenuates UVA-induced keratinocyte injury by inhibiting the ASK-1-JNK/p38 MAPK pathways.

Betanin Attenuates Epigenetic Mechanisms and UV-Induced DNA Fragmentation in HaCaT Cells: Implications for Skin Cancer Chemoprevention.

Dermal photoaging refers to the skin's response to prolonged and excessive ultraviolet (UV) exposure, resulting in inflammation, changes to the tissue, redness, swelling, and discomfort. Betanin is the primary betacyanin in red beetroot (Beta vulgaris) and has excellent antioxidant properties. Yet, the specific molecular mechanisms of betanin in HaCaT cells have not been fully clarified. The objective of this study was to investigate the activity of betanin and the underlying mechanisms in HaCaT cells; furthermore, in this study, we explored the protective effect of various concentrations of betanin against UVB irradiation on HaCaT cells. Additionally, we assessed its influence on the transcription of various epigenetic effectors, including members of the DNA methyltransferase (DNMT) and histone deacetylase (HDAC) families. Our findings demonstrate a notable downregulation of genes in HaCaT cells, exhibiting diverse patterns upon betanin intake. We considered the involvement of DNMT and HDAC genes in distinct stages of carcinogenesis and the limited exploration of the effects of daily exposure dosages. Our results indicate that betanin may protect the skin from damage caused by UV exposure. Further investigation is essential to explore these potential associations.

An observational study of personal ultraviolet dosimetry and acute diffuse reflectance skin changes at extreme altitude.

OBJECTIVE: To determine the level of UV radiation at extreme altitude and to assess the effect it has on the skin. METHODS: Fifteen expeditioners and 10 Sherpas were assessed during a climbing expedition on the north side of Mt Everest (8848 m). UV exposure measurement and diffuse skin reflectance spectrophotometry were performed at the beginning and end of the expedition. RESULTS: Over the course of the expedition, the expeditioners and Sherpas received a median dose of 93.6 (interquartile range [IQR], 61.0-102.8) and 102.5 (IQR, 72.2-117.8) minimal erythemal doses (MEDs) of UV radiation. The maximum dosage exceeded 106 ± 1.4 MEDs. Using reflectance spectrophotometry, expeditioner and Sherpa melanin-hemoglobin increased by 83.6% (IQR, -1.5 to 89.8%) and 24.7% (IQR, -22.4 to 61.5%) for exposed skin, respectively. The amount of subcutaneous lipid-water decreased by a factor of 196.6 (IQR, 52.1-308.4) and 46.7 (IQR, 1.8-1156.5), for expeditioners and Sherpas, respectively. CONCLUSIONS: This expedition's participants received massive doses of UV radiation during their time at high altitude. In many individuals this was similar to the annual exposure of northern European office-workers (100 MEDs). Diffuse skin reflectance spectroscopy revealed considerable subcutaneous lipid loss, skin dehydration, and increased melanin in keeping with these levels of exposure.

Efficacy of an appearance-based and a health-based sun protection intervention on summer vacationers' behaviours, PRISME cluster randomized crossover trial, France.

OBJECTIVES: Sun-seeking vacationers are particularly vulnerable to melanoma. Appearance-based interventions (ABi) showing skin damage of ultraviolet exposure may be a promising prevention tool to improve skin protection. This study aimed to measure and compare the efficacy of an ABi and a health-based intervention (HBi) on French summer vacationers' behaviours and to identify differences between subpopulations. DESIGN: A cluster randomized crossover trial with three intervention groups (control, ABi, HBi) was conducted in eight campsites on the French Mediterranean coast in summer 2019. METHODS: 1355 vacationers of both sexes and aged 12-55 years were included and followed up after 4 days (T1) and 14 months (T2). Efficacy of interventions was evaluated using multilevel mixed-effect models comparing groups on three outcomes: self-reported sun protection behaviours, sunbathing and skin colour measures. Protection behaviours were analysed according to subpopulations. RESULTS: Compared to controls, the ABi group had a higher protection and sunbathed for fewer hours at T1 and T2. In the HBi group, the skin colour was lighter than controls at T1. When comparing ABi to HBi, ABi participants had lower exposure than HBi at T1 and T2. The protection of people with a 3-years university degree was higher in the HBi group than in others groups while that of people with a secondary school certificate was higher in the ABi group. CONCLUSIONS: Our study provides further evidence of individual sun protection interventions effect in a touristic setting and highlights the relevance of ABi messages to supplement HBi messages, particularly in certain subpopulations with low to intermediate education levels.

Vitamin D Supplementation at a Dose of 10 µg/Day in Institutionalized Children with Severe Motor and Intellectual Disabilities.

Vitamin D (VD) deficiency can lead to health-related consequences. This study determined the effects of VD administration in VD-deficient children with severe motor and intellectual disabilities (SMID). Twenty-eight subjects were included. Among them, 25 subjects with parental consent for VD administration were given 10 µg/day (400 IU/day) of VD in April 2021. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at least 30 days after the start of VD administration. The total VD intake, serum 25(OH)D levels, and ultraviolet (UV) exposure before the blood tests were investigated. The results showed that the median serum 25(OH)D levels were 8.7 ng/mL (4.3-17.2) and 24.0 ng/mL (7.8-39 ng/mL) from March to May in 2020 and 2021, respectively. Among the 25 subjects, 22 with UV exposure had >20 ng/mL serum 25(OH)D level, and 2 without UV exposure had <20 ng/mL serum 25(OH)D level. Three subjects who did not receive VD supplementation had <20 ng/mL serum 25(OH)D level. Taken together, VD supplementation (10 µg/day) is effective in children with SMID in institutional care. Moreover, it may be sufficient for children with UV exposure, but not for those without.

The Association Between Aspirin and Basal Cell Carcinoma: A Clinical and Financial Analysis.

Background: Nonmelanoma skin cancer (NMSC) is the most common malignancy. Basal cell carcinoma (BCC) comprises about 80% of all NMSCs and its incidence continues to rise. Although BCC rarely leads to metastases or increased mortality, its effects on healthcare costs and quality of life are substantial. Aspirin may prevent the development of basal cell carcinoma (BCC) by the inhibition of cyclooxygenase (COX) enzymes, which are associated with carcinogenesis and inflammation. This study therefore examined the effect of aspirin on the risk of BCC, its clinical outcomes, and its treatment costs. Methods: A retrospective study (2010 - 2018) was conducted using the Humana Health Insurance Database. International Classification of Disease ninth and 10th codes and National Drug Codes were used to identify BCC diagnoses and aspirin prescriptions. Patients were matched for age, sex, Charlson Comorbidity Score (CCI), and region of residence. Chi-squared, logistic regression, and odds ratio (OR) analyses were utilized to test for significance and to estimate relative risk. Results: Aspirin use was associated with a decreased incidence of BCC in unmatched (OR = 0.658, 95% confidence interval (CI) 0.526 - 0.820) and matched (OR = 0.54, 95% CI 0.47 - 0.61) analyses. Aspirin was also associated with a decreased BCC risk when stratified by hypertension (P = 3.888 × 10-5), chronic obstructive pulmonary disease (COPD) (P = 0.014), diabetes (P = 0.049) and tobacco use (P = 0.017). Aspirin use was not associated with risk of BCC when stratified by obesity (P = 0.408). The average paid per patient for BCC treatment was significantly higher for patients in the aspirin use group than in the aspirin nonuse group (P = 0.0087). Conclusions: While the high incidence and cost of treatment of BCC are demanding both clinically and financially, the low cost of aspirin and its widespread use may have vital implications for its preventative role in this disease. This study concluded that aspirin use was associated with a significantly decreased risk of BCC.

Influence of Social and Psychosocial Factors on Summer Vacationers' Sun Protection Behaviors, the PRISME Study, France.

Objectives: Summer intermittent sun exposure is a major risk factor for melanoma. Socioeconomic position, cognitive and psychosocial factors play a role in sun protection behaviors but the underlying mechanisms are unknown. This study aimed to measure the influence of educational level on sun protection behaviors in French summer vacationers on the Mediterranean coastline, and to identify the mediating psychosocial factors in this pathway. Methods: In summer 2019, French vacationers aged 12-55 staying in coastline campsites were asked about their holiday sun protection behaviors, their knowledge, attitudes, perceived control, and social norm relative to sun protection. A structural equation model measured the direct and indirect effects of educational level on protection behaviors via cognitive and psychosocial factors. Results: Sun protection during vacation increased with educational level. Theoretical knowledge partially mediated this association, from 22% to 86%, particularly for intermediate educational levels. Conclusion: Our results highlight the importance of implementing suitable sun prevention interventions for vacationers, especially those with a lower socioeconomic position. Improving theoretical knowledge around sun protection may be an important part of broader efforts to encouraging improved preventive behaviors.

Asiaticoside delays senescence and attenuate generation of ROS in UV­exposure cells through regulates TGF­ß1/Smad pathway.

Asiaticoside, isolated from Centella asiatica, shows great improvement on wound healing and anti-oxidation function in vitro and in vivo. From previous research, asiaticoside possesses the potential capability to delay skin aging and reduce wrinkles clinically, but its underlying mechanism to regulate aging have not well-investigated. The present study found that asiaticoside could improve the viability and maintains a normal morphology in ultraviolet (UV)-exposure cells. In addition, ß-galactosidase release was inhibited by treatment of asiaticoside in UV damaged cells was observed. The present study confirmed that UV-induced ROS generation and SOD reduction could be attenuated by incubation of asiaticoside. By using RNA sequencing technology, differential genes between UV and asiaticoside treatment were demonstrated and enriched genes suggested that asiaticoside is able to negatively regulate cell cycle and MAPK pathways. Western blotting was employed to clarify the variation of key proteins in TGF-ß1/Smad pathway and cell cycle and the result implied that asiaticoside is capable of attenuating upregulation of TGF-ß1, Smad2 and Smad3 to reverse cell senescence. The present study investigated regulation of asiaticoside to TGF-ß1/Smad pathway in UV-induced HaCat cells, showing its potential to against photoaging.

Stimulating Sunscreen Use Among Outdoor Construction Workers: A Pilot Study.

Background: Outdoor workers (OW) receive a higher dose of ultraviolet radiation (UVR) compared to indoor workers (IW) which increases the risk of non-melanoma skin cancer (NMSC). Regular sunscreen use reduces the NMSC risk, however, adequate sun-safety behavior among OW is poor. The main objective was to conduct method- and intervention-related elements of a future intervention trial among OW, based on providing sunscreen and assessing sunscreen use on group- and individual level. Methods: This pilot study was conducted at a construction site in the Netherlands from May-August 2021. Nine dispensers with sunscreen (SPF 50+) were installed at the worksite. OW (n = 67) were invited to complete two (cross-sectional) questionnaires on sun-safety behavior, before and after providing sunscreen. Stratum corneum (SC) samples for the assessment of UV-biomarkers were collected from the forehead and behind the ear from 15 OW and 15 IW. The feasibility of the following elements was investigated: recruitment, (loss to) follow-up, outcome measures, data collection, and acceptability of the intervention. Results: The first questionnaire was completed by 27 OW, the second by 17 OW. More than 75 percent of the OW were aware of the risks of sun exposure, and 63% (n = 17) found sunscreen use during worktime important. The proportion of OW never applying sunscreen in the past month was 44.4% (n = 12) before, and 35.3% (n = 6) after providing sunscreen. A majority of OW (59.3%, n = 16) found sunscreen provision encouraging for sunscreen use, the dispensers easy to use (64.7%, n = 17) and placed in practical spots (58.8%, n = 18). Collecting SC-samples was fast and easy, and several UV-biomarkers showed higher levels for sun-exposed compared to less exposed body parts. There was no significant difference in UV-biomarker levels between OW and IW. Conclusions: This pilot study revealed low sunscreen use among OW despite providing sunscreen, overall satisfaction with the sunscreen, and the sufficient awareness of the risks of UVR-exposure. Collecting SC-samples at the workplace is feasible and several UV-biomarkers showed to be promising in assessing UVR-exposure. The low participation rate and high loss to follow-up poses a challenge for future intervention studies.