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Background: While ultraviolet radiation (UVR) present in sunlight is recognized as the main etiological agent of skin cancer, the most frequent form of which is basal cell carcinoma (BCC), other exposome factors like pollution, diet, and lifestyle may also contribute. This study aimed to investigate the association of BCC and exposome‐related factors in the Spanish population. Methods: BCC cases (n = 119) and controls (n = 127) with no history of skin cancer were recruited between April 2020 and August 2022 by 13 dermatologists throughout Spain in this prospective multicenter case–control study. Results: The BCC group had a higher proportion of outdoor workers, more years of UVR exposure, and a greater consumption of drugs (statins, ASA, hydrochlorothiazide, ACE inhibitors and omeprazole), P < 0.05. Avoidance of sun exposure was the most used photoprotection measure in both groups. The use of hats or caps was higher in the BCC group (P = 0.01). The solar protection factor (SPF) used 15 years previously was higher in the control group (P = 0.04). The control group had a higher daily screen time (P < 0.001), and practiced more relaxation activities (P = 0.03). Higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with BCC (P < 0.05). Statistical significance for all the aforementioned variables was maintained in the multivariate analysis (P < 0.05). Conclusions: The study found a significant association between BCC and multiple exposome‐related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers, promoting sun‐safe behaviors and stress‐reducing activities, and also adequate skin photoprotection in patients on certain medications associated with increased BCC risk. [ABSTRACT FROM AUTHOR]

Simple Summary: The influence of different exposome factors on squamous cell carcinoma has been studied in several articles, although generally including a limited number of factors, especially chronic sun exposure. We carried out a prospective multicenter case–control study of patients with a history of squamous cell carcinoma and a control group with no previous history of skin cancer, in which we compared most of the exposome variables, including sun exposure, photoprotection habits, diet, pollution, stress, and lifestyle. We found a significant association between squamous cell carcinoma and multiple exposome-related factors besides chronic sun exposure in the Spanish population. A better understanding of the actual impact of exposome in this condition could help design primary prevention strategies targeted at specific populations or risk behaviors. Introduction: The concept of exposome refers to the total of harmful and beneficial environmental exposures that can help predict the organism's biological responses over time. Ultraviolet radiation (UVR) from sun exposure has been recognized as the main etiological agent of skin cancer, and squamous cell carcinoma (SCC) is one most commonly associated with chronic exposure. However, in recent years, evidence suggests that lifestyle, environmental pollution, and contaminants in water and food can have an influence. Objectives: To study the relationship between SCC and sun exposure, pollution, stress, and lifestyle in a Spanish cohort. Materials and Method: A multicenter case–control study was carried out in which 13 dermatologists from different regions of Spain recruited cases and controls between April 2020 and August 2022. The group of cases were patients diagnosed with SCC and, as a control group, people who attended Dermatology consultations as companions with no history of skin cancer. Results: A total of 62 patients with SCC and 126 controls were included (62.9% males, median age 76.46 (10.1) and 33.3%, median age 55.7 (15), respectively). The SCC group had experienced more outside work than the controls (75% vs. 22.4%, p < 0.001), less recreational exposure (sunbathing, p = 0.05, and outdoor sports, p = 0.01), and a lower annual income (p = 0.01), with an increase in tobacco exposure (p < 0.001), without differences in other carcinogens, such as ionizing radiation or chemical exposure. The control group had a higher daily screentime use (p < 0.001) and practiced more relaxation activities (p = 0.03). A higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with SCC (p < 0.05). Some chronic medications (anxiolytics, antidepressants, beta-blockers, statins, hydrochlorothiazide, ACE inhibitors, metformin, and omeprazole) were also statistically associated with SCC. Statistical significance for all aforementioned variables was maintained in the multivariate analysis (p < 0.05). Conclusions: The study found a significant association between SCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers promoting sun-safe behaviors and stress-reducing activities, in addition to adequate skin photoprotection in patients under certain medications associated with SCC. [ABSTRACT FROM AUTHOR]

Methyl aminolevulinate daylight photodynamic therapy (MAL DL‐PDT) is highly efficacious for the treatment of nonhyperkeratotic actinic keratosis (AK), even when partially performed at home. To evaluate the long‐term effectiveness, safety, and patient‐reported outcomes of MAL DL‐PDT performed completely by the patient in real life conditions. An open prospective study was conducted in Spain among patients diagnosed with at least five AK lesions on the face or the scalp. Patients received instruction and information in infographic format to perform MAL DL‐PDT at home. All had been treated with 30% urea daily for 7 days before the day of MAL DL‐PDT. Meteorological conditions on the day of the treatment and adverse effects were recorded. Patients underwent follow‐up, and a second session of home‐based MAL DL‐PDT if deemed necessary, 3, 6, and 12 months after the initial treatment session. The study population consisted of 22 patients (19 men and three women, mean [standard deviation, SD] age, 72.05 [6.96] years). A complete response was observed in 47.7% of AK lesions at 3 months (p < 0.001) and 65.9% (n = 199) at 12 months (p < 0.001). Olsen grade II lesions showed the highest rate of response (76.07% at 12 months). The mean (SD) actinic keratosis area and severity index score decreased significantly from 4.99 (2.43) at baseline to 2.33 (1.01) at 12 months (p = 0.0234). Adverse effects were mild and expected. A majority of patients were "satisfied" or "very satisfied" with the treatment instruction provided (90.9%) and the treatment outcome (72.7%). MAL DL‐PDT can be applied at home like any other topical treatment for AK. Our results indicate good long‐term effectiveness, a high level of patient satisfaction, and no significant side effects. [ABSTRACT FROM AUTHOR]

Background: Solar ultraviolet radiation (UVR) is one of the main risk factors for non-melanoma skin cancer. In Spain, 11% of the population are outdoor workers. Farmers are among the outdoor workers with the highest levels of chronic sun exposure., Objectives: To study the prevalence of skin cancer in farmers and evaluate their photoprotection habits., Materials & Methods: We performed an observational cross-sectional prospective study of farmers who completed a validated questionnaire on UVR exposure and protective behaviour and underwent a skin examination and skin colorimetry overseen by a dermatologist., Results: The study population consisted of 215 farm workers (84.4% male; mean age: 65.8 ± 14 years; mean years working: 45 ± 18). Actinic keratosis (AK) was detected in 41.4%, basal cell carcinoma (BCC) in 9.8%, and squamous cell carcinoma (SCC) in 1.4%. The most frequent photoprotection measure was the shade (69.3%). Photoaging type was significantly associated with the presence of AK and BCC, and Olson Grade II and III AK lesions correlated with SCC. The number of nevi on the lower extremities was the only predictor of the appearance of BCC., Conclusion: Photoprotection measures were not regularly used by most farm workers and the prevalence of skin cancer lesions was high. The findings underscore the need to improve photoprotection habits and early detection of skin cancer in this population.