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Sunscreen use is an important aspect of sun protective behavior. Previous studies revealed deficits in sunscreen use. Our aim was to quantify sunscreen use in a nationwide representative study in Germany as well as to develop and test an item battery on reasons for none use of sunscreen. We analyzed data of the National Cancer Aid Monitoring (NCAM; wave 4; n = 3000, aged 14–45). To describe those who only use sunscreen rarely or never, we used chi2 statistics and logistic regression analysis. In addition, we utilized a newly developed item battery on barriers to sunscreen use. Here, we used Cronbach’s alpha to investigate reliability. In total, 20.7% reported using sunscreen rarely or never. Infrequent or none use of sunscreen was associated with male sex, immigrant background, none or rare sunbathing in summer, and current or past use of sunbeds. Participants with higher skin cancer risk (e.g., pale skin) were less likely to use sunscreen infrequently or never. The major reasons for not using sunscreen were inconvenience and no perceived need for applying sunscreen. Overall, internal consistency of the item battery on potential barriers to sunscreen use was very good (Cronbach’s alpha = 0.865). We found deficits in sunscreen use especially in sunbed users, men, and individuals with immigrant background. Our results give important implications for future prevention and health promotion campaigns on sunscreen use.

Outdoor and indoor tanning are considered as risk factors for the development of skin cancer. The aims of this nationwide representative study were to quantify both behaviors in a sample with a wide age range, to identify those showing both behaviors and to explore and compare determinants of both behaviors. We used data from the fifth wave (2019) of the National Cancer Aid Monitoring (NCAM). We surveyed the representative sample including 4000 individuals, aged 16–65 years, living in Germany. Data were collected through telephone interviews. In addition to descriptive statistics, we used logistic regression analyses to identify determinants. The one-year-prevalence of tanning bed use was 7.5%, while 31.9% tanned (very) often intentionally outdoors in at least one situation (weekdays, holidays, and weekends). A total of 3.2% reported both risk behaviors. Regression analyses revealed that tanning bed use is associated with employment, an increased number of naevi, and lack of risk awareness. Intentional outdoor tanning was associated with male sex, younger age, past tobacco use, and low risk awareness of UV radiation. Our findings suggest that only a minority of subjects showed both risk behaviors. This implies that individuals seem to perform either one behavior or the other. In addition, the associated determinants differed between both behaviors, implying that specific preventive measures tailored to address to each tanning behavior are needed.

Background The use of sunscreen can reduce the risk of UV-induced skin lesions. Health authorities have provided recommendations for the correct use of sunscreen use: Sufficient amount of sunscreen should be applied at least 30 min before the sun exposure and should be reapplied every 2 h. Objective We aimed to research the practice of sunscreen use in a population-based and representative sample in Germany. Methods For this cross-sectional survey, 3000 German residents aged 14-45 years were surveyed in standardized telephone interviews in 2018. Survey participants provided data on the frequency of sunscreen use in summer, timing of (re-)application and their skin characteristics. The data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample. Results Overall, 79.4% of respondents used sunscreen always, often or sometimes when being exposed to the sun. However, 87.2% of sunscreen users did not follow the recommendations on timing of application, 59.5% did not comply with the timing of reapplication. We also saw, that people potentially used too little sunscreen. These data did not differ noticeably by skin types of participants. Conclusion Our study revealed deficits in use of sunscreen in Germany, indicating that people here pay little attention to the recommendations of health authorities, regardless of their skin type. There is therefore an urgent need for targeted public information on this issue. Improving public knowledge on correct sunscreen use through educational campaigns or individual counselling by health professionals could be a first step.

This paper summarises the view of the German Commission on Radiological Protection ("Strahlenschutzkommission", SSK) on the rationale behind the currently valid dose limits and dose constraints for workers recommended by the International Commission on Radiological Protection (ICRP). The paper includes a discussion of the reasoning behind current dose limits followed by a discussion of the detriment used by ICRP as a measure for stochastic health effects. Studies on radiation-induced cancer are reviewed because this endpoint represents the most important contribution to detriment. Recent findings on radiation-induced circulatory disease that are currently not included in detriment calculation are also reviewed. It appeared that for detriment calculations the contribution of circulatory diseases plays only a secondary role, although the uncertainties involved in their risk estimates are considerable. These discussions are complemented by a review of the procedures currently in use in Germany, or in discussion elsewhere, to define limits for genotoxic carcinogens. To put these concepts in perspective, actual occupational radiation exposures are exemplified with data from Germany, for the year 2012, and regulations in Germany are compared to the recommendations issued by ICRP. Conclusions include, among others, considerations on radiation protection concepts currently in use and recommendations of the SSK on the limitation of annual effective dose and effective dose cumulated over a whole working life.

Hintergrund Die internationale Forschung hat gezeigt, dass Personen dazu neigen, sich selbst als weniger anfallig fur Krankheiten und gesundheitliche Folgen von Risikoverhalten zu sehen als andere Vergleichspersonen. Unser Ziel war es, diesen Effekt, bekannt als unrealistischer komparativer Optimismus (UKO), in Bezug auf Hautkrebs erstmals in einer bundesweit reprasentativen Stichprobe zu untersuchen. Die Ergebnisse sind von Relevanz fur die Planung zukunftiger Praventionsmasnahmen. Methoden Das Nationale Krebshilfe-Monitoring zur Solariennutzung (NCAM, Erhebungswelle 3) ist eine bundesweit reprasentative Befragung (n = 3000, 14-45 Jahre). Wir haben UKO in Bezug auf Hautkrebs exploriert und den Zusammenhang zwischen UKO und soziodemographischen Merkmalen, braunungs- und gesundheitsbezogenem Risikoverhalten, Hautkrebsrisiko und Risikobewusstsein gegenuber Hautkrebs untersucht. Ergebnisse Vier von zehn Personen (43,3 %) glaubten - im Vergleich zu einer Person gleichen Alters und Geschlechts - ein geringeres Risiko zu haben, an Hautkrebs zu erkranken. Jungere Personen zeigten mit hoherer Wahrscheinlichkeit eine optimistische Wahrnehmung. Personen mit erhohtem Hautkrebsrisiko, gemessen an individuellen Hautcharakteristika, nahmen ihr Risiko verglichen zur Referenz auch mit erhohter Wahrscheinlichkeit wahr. Schlussfolgerungen Wahrend es realistisch ist, dass Personen mit einem erhohten objektiven Hautkrebsrisiko dies auch so wahrnehmen, sind die generellen Untersuchungsbefunde fur die Allgemeinbevolkerung, speziell fur jungere Personen, besorgniserregend. Es scheint daher wichtig, Personen uber ihre unrealistische Wahrnehmung bezuglich des eigenen Hautkrebsrisikos aufzuklaren, da dies das wahrgenommene individuelle Risiko sowie das individuelle Screening- und Praventionsverhalten beeinflussen kann.

Up to 40% of advance lung, melanoma and breast cancer patients suffer from brain metastases (BM) with increasing incidence. Here, we assessed whether circulating tumor cells (CTCs) in peripheral blood can serve as a disease surrogate, focusing on CD44 and CD74 expression as prognostic markers for BM. We show that a size-based microfluidic approach in combination with a semi-automated cell recognition system are well suited for CTC detection in BM patients and allow further characterization of tumor cells potentially derived from BM. CTCs were found in 50% (7/14) of breast cancer, 50% (9/18) of non-small cell lung cancer (NSCLC) and 36% (4/11) of melanoma patients. The next-generation sequencing (NGS) analysis of nine single CTCs from one breast cancer patient revealed three different CNV profile groups as well as a resistance causing ERS1 mutation. CD44 and CD74 were expressed on most CTCs and their expression was strongly correlated, whereas matched breast cancer BM tissues were much less frequently expressing CD44 and CD74 (negative in 46% and 54%, respectively). Thus, plasticity of CD44 and CD74 expression during trafficking of CTCs in the circulation might be the result of adaptation strategies.

The International Agency for Research on Cancer classified, in July 2009, exposure to artificial tanning devices (sunbeds) as carcinogenic to humans. This classification was based on evidence from epidemiological and experimental animal studies. The present chapter will review these epidemiological evidences. The summary risk estimates from 27 epidemiological studies obtained through a meta-analysis showed an increased risk of melanoma: summary relative risk (SRR) = 1.20 [95% confidence interval (CI) 1.08-1.34]. The risk was higher when exposure took place at younger age (SRR = 1.59; 95% CI 1.36-1.85). The risk was independent of skin sensitivity or population and a dose response was evident. A meta-analysis of 12 studies was conducted for non-melanoma skin cancers and showed a significantly increased risk for basal cell carcinoma (SRR = 1.29; 95% CI 1.08-1.53) and for squamous cell carcinoma (SRR = 1.67; 95% CI 1.29-2.17). As for melanoma, the risk for other skin cancers increased for first exposures at young age. Epidemiological studies have gradually strengthened the evidence for a causal relationship between indoor tanning and skin cancer and they fit with prior knowledge on relationship between UV exposure and skin cancer. Additionally, several case-control studies provided consistent evidence of a positive association between use of sunbed and ocular melanoma, also with greater risk for first exposures at younger age. Preventive measures based on information on risk or by requiring parental authorization for young users proved to be inefficient in several studies. The significant impact of strong actions or total ban, such as performed in Iceland, or a total ban of sunbed use, as in Brazil or Australian states, needs to be further assessed.

Actinic keratoses (AKs) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guidelines for actinic keratosis and cutaneous squamous cell carcinoma were developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guidelines are aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AKs and cSCC. The guidelines are also aimed at affected patients, their relatives, policy makers and insurance funds. In the second part, we will address aspects relating to epidemiology, etiology, surgical and systemic treatment of cSCC, follow-up and disease prevention, and discuss AKs and cSCC in the context of occupational disease regulations.

Actinic keratoses (AK) are common lesions in light‐skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence‐based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guideline is aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office‐based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AK and cSCC. The guideline is also aimed at affected patients, their relatives, policy makers and insurance funds. In the first part, we will address aspects relating to diagnosis, interventions for AK, care structures and quality‐of‐care indicators.

Early detection is considered to improve the prognosis of cutaneous melanoma. The value of population-based screening for melanoma, however, is still controversial. The aim of this study was to evaluate the predictive power of established risk factors in the setting of a population-based screening and to provide empirical evidence for potential risk stratifications. We reanalyzed data (including age, sex, risk factors, and screening results) of 354 635 participants in the Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany (SCREEN)project conducted in the German state of Schleswig-Holstein (2003-2004). In multivariable analysis, atypical nevi [odds ratio (OR): 17.4; 95% confidence interval (CI): 14.4-20.1], personal history of melanoma (OR: 5.3; 95% CI: 3.6-7.6), and multiple (≥40) common nevi (OR: 1.3; 95% CI: 1.1-1.6) were associated with an increased risk of melanoma detection. Family history and congenital nevi were not significantly associated with melanoma detection in the SCREEN. The effects of several risk-adapted screening strategies were evaluated. Hypothesizing a screening of individuals aged more than or equal to 35 years, irrespective of risk factors (age approach), the number needed to screen is 559 (95% CI: 514-612), whereas a screening of adults (aged ≥20) with at least one risk factor (risk approach) leads to a number needed to screen of 178 (95% CI: 163-196). Converted into one screen-detected melanoma, the number of missed melanomas is 0.15 (95% CI: 0.12-0.18) with the age approach and 0.22 (95% CI: 0.19-0.26) with the risk approach. The results indicate that focusing on individuals at high risk for melanoma may improve the cost-effectiveness and the benefit-to-harm balance of melanoma screening programs.

BACKGROUND Sunless tanning products (STPs) are often seen as "healthy alternative" to sunbathing and indoor tanning. However, STP use may entail indirect risks such as overestimating an individual's natural skin type, resulting in risky (natural and artificial) tanning behavior. We aimed to explore STP use in combination with other health-related risk behaviors (eg, smoking), skin cancer risk, risk awareness of ultraviolet radiation, and preventive behavior. METHODS We used data from the NCAM, a nationwide representative cross-sectional sample (n = 3000, aged 14-45, 48.6% female) interviewed via telephone. Differences between STP users and nonusers regarding the abovementioned aspects were identified using chi²-test. RESULTS The 1-year prevalence of STP use was 7.5%. Tanning bed users showed a higher prevalence of STP use than past and never users (16.1% vs 9.6% vs 5.8%, P

ZusammenfassungHintergrund und Ziele Das Projekt „Nationales Krebshilfe-Monitoring zur Solariennutzung“ (National Cancer Aid Monitoring of Tanning Bed Use, NCAM) ist eine deutsche Grosstudie mit dem Ziel, die wichtigsten Risikofaktoren fur Hautkrebs zu beobachten: naturliches Sonnenlicht und kunstliche UV-Strahlung. Teilnehmer und Methoden NCAM ist eine bundesweite Querschnittstudie mit zunachst vier Runden der Datenerfassung (sogenannten Wellen) zwischen 2015 und 2018. Jedes Jahr wird eine bundesweit reprasentative Stichprobe aus 3.000 Personen im Alter von 14 bis 45 Jahren befragt. Die Querschnittsbefragung wird durch eine Kohorte von n = 450 aktuellen Solariennutzern erganzt. Ergebnisse Die erste Welle im Jahr 2015 ergab eine Gesamtpravalenz der Solariennutzung von 29,5 %. Elf Prozent aller Teilnehmer hatten in den vergangenen zwolf Monaten ein Solarium genutzt. Zu den Determinanten der aktuellen Solariennutzung gehorten jungeres Alter, weibliches Geschlecht und Vollzeit-/Teilzeitbeschaftigung. Die hauptsachlichen Beweggrunde, die fur die Nutzung eines Solariums genannt wurden, waren Entspannung und Attraktivitatssteigerung. Schlussfolgerungen NCAM ist weltweit die erste Studie zur Uberwachung der Risikofaktoren fur Hautkrebs in jahrlichen Intervallen anhand einer grosen, landesweit reprasentativen Stichprobe. Erste Ergebnisse deuten darauf hin, dass Millionen Deutsche trotz Warnungen der WHO Solarien nutzen, und dass viele dieser Nutzer Jugendliche sind - trotz gesetzlicher Beschrankungen, die das Ziel haben, die Nutzung von Solarien durch Minderjahrige zu verhindern.

BACKGROUND In July 2008, the German statutory health insurance introduced a nationwide skin cancer screening program. Before the introduction, eligible physicians had to qualify to perform the screening test and counsel their patients on skin cancer screening. To educate physicians, a curriculum and training materials were developed. Since 2015 a revised curriculum and training materials have been used. The purpose of this paper is to provide information about the curriculum and to evaluate the revised training program. METHODS A total of 573 completed pre- and posttests were analyzed with regard to changes in the identification of skin cancer, diagnostic accuracy, knowledge, and physicians' self-assessed-confidence. For statistical analysis, Mann-Whitney U test, Cohen's d, and chi-square test were used. RESULTS General practitioners (GPs) diagnosed 7.45 of 12 skin lesions correctly before and 9.26 after the training course (P < 0.001). Compared to GPs, dermatologists' accuracy was higher at pre- and posttest (pre: 10.03, post: 10.21, P = 0.160). The mean of correctly answered questions increased significantly in knowledge on screening and early detection (4.46-5.14, P < 0.001) as well as skin cancer and skin cancer screening (5.51-6.39, P < 0.001). CONCLUSION Participating physicians got a comprehensive understanding of skin cancer screening and counseling through the training and increased their diagnostic skills. In particular, GPs identified and diagnosed significantly more skin lesions correctly after the training compared to before the training, while dermatologists' diagnostic skills were high at both times, before and after.

SummaryBackground and objectives The National Cancer Aid Monitoring of Tanning Bed Use (NCAM) project is a major German study that aims to observe the most significant risk factors for skin cancer: natural sunlight and artificial UV radiation. Participants and methods NCAM is a nationwide cross-sectional survey that will initially involve four rounds of data collection (so-called waves) between 2015 and 2018. Every year, a representative nationwide sample consisting of 3,000 individuals aged between 14 and 45 years will be surveyed. The cross-sectional survey will be complemented by a panel of n = 450 current tanning bed users. Results The initial wave in 2015 shows an overall prevalence of tanning bed use of 29.5 %. Eleven percent of all participants had used a tanning bed within the past twelve months. Determinants of current tanning bed use included younger age, female gender, and full-time/part-time employment. The main motivations for tanning bed use reported were relaxation and increased attractiveness. Conclusions NCAM is the first study worldwide to monitor skin cancer risk factors at one-year intervals using a large, nationally representative sample. Initial results indicate that, despite WHO warnings, millions of Germans use tanning beds, and that many of these users are adolescents despite legal restrictions aimed at preventing minors from using tanning beds.

Background The incidence rate of melanoma in the Caucasian population is rising worldwide. One of the major environmental risk factors for melanoma is the exposure to ultraviolet (UV) radiation. To prevent skin damage caused by UV exposure, several organizations recommend wearing protective clothing, staying in the shade, avoiding the outdoors during midday, and using sunscreen. Objective to provide representative data on factors associated with sun-protective behaviors and intentional sun exposure during summertime in the German population. Methods A population-based sample of 3,000 German residents aged 14 to 45 years (response: 32.1%) was interviewed via telephone from October to December 2015. Survey participants provided data on the use of recommended sun-protective measures on a sunny summer day and their intentional sun exposure during summertime. Data were weighted by age, sex, educational level, and federal state to ensure the national representativeness of the sample. Results Wearing long-sleeved clothes was the most frequently reported protective measure (53.9%), while wearing headgear was the least common (17.9%). Significantly lower frequencies of almost all recommended sun-protective measures were identified for males, participants between 14 and 25 years, those with an immigrant background, and those with low levels of education. Using sun protection was positively associated with female gender (OR=1.62), higher levels of education (ORhigh=1.27), sunburn during childhood (OR=1.33), and paying attention to healthy nutrition (OR=1.64; all p

We demonstrate label-free multimodal multiphoton microscopy in human skin tissue with an ultrafast Er:fiber-laserbased source that emits femtosecond pulses at 775 nm and 1250 nm. This novel two-color fiber-based source enables second-harmonic generation, third-harmonic generation, and two-photon excitation fluorescence, which serves as a potential solution to optical virtual skin biopsy with compactness, robustness, and cost-effectiveness.

UV exposure is the main risk factor for development of cutaneous squamous cell carcinoma (cSCC). While early detection greatly improves cSCC prognosis, locally advanced or metastatic cSCC has a severely impaired prognosis. Notably, the mechanisms of progression to metastatic cSCC are not well understood. We hypothesized that UV exposure of already transformed epithelial cSCC cells further induces changes which might be involved in the progression to metastatic cSCCs and that UV-inducible microRNAs (miRNAs) might play an important role. Thus, we analyzed the impact of UV radiation of different quality (UVA, UVB, UVA + UVB) on the miRNA expression pattern in established cell lines generated from primary and metastatic cSCCs (Met-1, Met-4) using the NanoString nCounter platform. This analysis revealed that the expression pattern of miRNAs depends on both the cell line used per se and on the quality of UV radiation. Comparison of UV-induced miRNAs in cSCC cell lines established from a primary tumor (Met-1) and the respective (un-irradiated) metastasis (Met-4) suggest that miR-7-5p, miR-29a-3p and miR-183-5p are involved in a UV-driven pathway of progression to metastasis. This notion is supported by the fact that these three miRNAs build up a network of 81 potential target genes involved e.g. in UVA/UVB-induced MAPK signaling and regulation of the epithelial–mesenchymal transition. As an example, PTEN, a target of UV-upregulated miRNAs (miR-29a-3p, miR-183-5p), could be shown to be down-regulated in response to UV radiation. We further identified CNOT8, the transcription complex subunit 8 of the CCR4-NOT complex, a deadenylase removing the poly(A) tail from miRNA-destabilized mRNAs, in the center of this network, targeted by all three miRNAs. In summary, our results demonstrate that UV radiation induces an miRNA expression pattern in primary SCC cell line partly resembling those of metastatic cell line, thus suggesting that UV radiation impacts SCC progression beyond initiation.

Aktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte, klinische Entscheidungsfindung zu unterstützen, wurde die Leitlinie “Aktinische Keratose und Plattenepithelkarzinom der Haut” auf der Methodikebene S3 nach dem Regelwerk der AWMF entwickelt. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, die sich mit der Diagnose und Behandlung von Patienten mit AK und PEK befassen. Die Leitlinie richtet sich auch an betroffene Patienten, deren Angehörige, politische Entscheidungsträger und Versicherungsgesellschaften. In diesem Teil behandeln wir die Themen Diagnostik, Interventionen bei AK, Versorgungsstrukturen und Qualitätsindikatoren.

Aktinische Keratosen (AK) sind haufige Hautveranderungen bei hellhautigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) uberzugehen. Beide Erkrankungen konnen mit erheblicher Morbiditat verbunden sein und stellen eine grose Krankheitslast insbesondere in der alteren Bevolkerung dar. Um eine evidenzbasierte, klinische Entscheidungsfindung zu unterstutzen, wurde die Leitlinie „Aktinische Keratose und kutanes Plattenepithelkarzinom“ auf der Methodikebene S3 nach dem Regelwerk der AWMF entwickelt. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO-Arzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, die sich mit der Diagnose und Behandlung von Patienten mit AK und PEK befassen. Die Leitlinie richtet sich auch an betroffene Patienten, deren Angehorige, politische Entscheidungstrager und Versicherungsgesellschaften. In diesem Teil behandeln wir die Themen Epidemiologie, Atiologie, chirurgische und systemische Behandlung des PEK, Nachsorge des PEK, Pravention und Berufskrankheit durch AK und PEK.

Indoor tanning is an important risk factor for the development of melanoma and non-melanoma skin cancer. With our nationally representative monitoring, we aimed at describing tanning bed use, user characteristics, reasons for use, and risk awareness over time. In the framework of the National Cancer Aid Monitoring (NCAM), we collected representative data on 12,000 individuals aged 14 to 45 years in annual waves of n = 3,000 participants in Germany between 2015 and 2018. We used descriptive statistics and chi&sup2, tests to uncover group differences. To compare data from the different waves, we calculated confidence intervals. The use of tanning beds decreased from 2015 (11.0%, 95%-CI: 9.9%&ndash, 12.1%) to 2018 (8.8%, 95%-CI: 7.8%&ndash, 9.8%). However, this decrease did not affect all subgroups. For instance, there was an (non-significant) increase in minors and the prevalence remained stable for individuals with immigrant background and males. Attractiveness was an important reason for tanning bed use in each wave. Over time, there was an increase in medical-related reasons for use. Furthermore, monitoring showed a decrease in risk awareness regarding tanning bed use and ultraviolet (UV) radiation. While it is a positive development that the overall use of tanning beds in Germany has decreased over time, the increasing use by minors despite the legal ban is alarming. Due to the declining risk awareness it is necessary to implement prevention and education campaigns specifically targeted at this group.

Multiphoton microscopy (MPM) is an important bio-imaging tool. Different modalities can serve as a contrast agent, such as second-/third-harmonic generation (SHG/THG) and two-/three-photon excitation fluorescence (2PEF/3PEF). Ultrafast lasers with flexible wavelength tunability are crucial for driving MPM bio-imaging, and the conventional solution relies on ultrafast Ti:sapphire lasers plus an optical parametric oscillator/amplifier. Recently, we have demonstrated that ultrafast fiber lasers are a potential solution to implementing compact, robust, and wavelength tunable femtosecond sources for driving MPM. To realize wavelength tunability we employ self-phase modulation (SPM) in optical fibers to broaden a narrowband input spectrum of Yb-/Er-doped fiber lasers (YDFLs/EDFLs) up to >400-nm wide with well-isolated spectral lobes; filtering the leftmost/rightmost lobes leads to nearly transform-limited pulses [1–6]. Such a SPM-enabled spectral selection (SESS) allows us to obtain wavelength widely tunable femtosecond pulses for MPM [2,5,6].

Ultraviolet B (UVB) radiation induces mutagenic DNA photolesions in skin cells especially in form of cyclobutane pyrimidine dimers (CPDs). Protection mechanisms as DNA repair and apoptosis are of great importance in order to prevent skin carcinogenesis. In human skin, neural crest-derived precursors of melanocytes, the dermal stem cells (DSCs), are discussed to be at the origin of melanoma. Although they are constantly exposed to solar UV radiation, it is still not investigated how DSCs cope with UV-induced DNA damage. Here, we report a comparative study of the DNA damage response after irradiation with a physiological relevant UVB dose in DSCs in comparison to fibroblasts, melanocytes and keratinocytes isolated from human foreskin. Within our experimental settings, DSCs were able to repair DNA photolesions as efficient as the other skin cell types with solely keratinocytes repairing significantly faster. Interestingly, only fibroblasts showed significant alterations in cell cycle distribution in terms of a transient S phase arrest following irradiation. Moreover, with the applied UVB dose none of the examined cell types was prone to UVB-induced apoptosis. This may cause persistent genomic alterations and in case of DSCs it may have severe consequences for their daughter cells, the differentiated melanocytes. Altogether, this is the first study demonstrating a similar UV response in dermal stem cells compared to differentiated skin cells.

We demonstrate fiber-based two-color sources that produce femtosecond pulses in two biomedical transmission windows (800 and 1300 nm). This powerful source enables multiphoton microscopy for both virtual skin biopsy and protein nano-crystal scoring.

OBJECTIVE The aim of the National Cancer Aid Monitoring (NCAM) was to investigate which occupational groups (1) show higher sun exposure time, (2) suffer from sunburn, and (3) use recommended protective measures. METHODS In 2016, a total of 485 individuals were classified as outdoor workers in accordance with ISCO-08 and asked about exposure time, prevalence of sunburn, and personal sun-protective measures on a sunny summer day. RESULTS Outdoor workers were exposed to ultraviolet (UV) radiation for a mean time of 23.6 ± 15.3 hours per week. The 12-month prevalence of getting sunburnt at work was 19%. Only one-third of outdoor workers reported using five of the most important protective measures "often" or "always." CONCLUSION The NCAM revealed a number of high-risk groups, whose sun-protective behavior has scarcely been studied up to now.

Solarienstrahlung wurde jungst von der International Agency for Research on Cancer (IARC) als krebserregend eingestuft. Anders als in anderen Nationen war die Datenlage zu diesem dermatologisch wichtigen Risikofaktor in Deutschland bis zuletzt mangelhaft. Ziel der SUN-Study 2012 (Sunbed-Use: Needs for Action Study) war daher die Ermittlung epidemiologischer Pravalenzdaten zu diesem vollig vermeidbaren Risikofaktor. Es wurden 4851 Personen im Alter zwischen 14 und 45 Jahren zufallig und reprasentativ aus der bundesdeutschen Bevolkerung ausgewahlt und mittels standardisierter Telefoninterviews befragt. Der Befragungszeitraum wurde in eine Sommer- und eine Winterwelle gesplittet, um mogliche Jahreszeiteffekte zu berucksichtigen. Vier von 10 Deutschen im Alter von 14 bis 45 Jahren [39,2 % (95 %-KI: 37,8–40,6 %)] waren schon einmal in einem Solarium. Innerhalb des letzten Jahres hatten 14,6 % (95 %-KI: 13,6–15,6 %) ein Solarium besucht. Die durchschnittliche Nutzung lag bei derzeitigen Nutzern bei 6 Besuchen pro Jahr. Unter den derzeitigen Solariennutzern hatte jeder Zwanzigste eine familiare Vorgeschichte eines malignen Melanoms bei Verwandten ersten Grades. Uber 5 % aller Minderjahrigen besuchen trotz des bundesweiten Verbots zurzeit Solarien – meist an unbeaufsichtigten Standorten. Die Halfte dieser Minderjahrigen kannte das gesetzliche Solarienverbot fur Minderjahrige nicht. Unsere Studie belegt, dass die Solariennutzung als ein wichtiger Risikofaktor fur Hautkrebs weit verbreitet ist. In der deutschen Bevolkerung bestehen zudem deutliche Informationsdefizite uber die Gesundheitsrisiken von Solarien.

Ultraviolet radiation (UVR) is part of the electromagnetic spectrum emitted naturally from the sun or from artificial sources such as tanning devices. Acute skin reactions induced by UVR exposure are erythema (skin reddening), or sunburn, and the acquisition of a suntan triggered by UVR-induced DNA damage. UVR exposure is the main cause of skin cancer, including cutaneous malignant melanoma, basal-cell carcinoma, and squamous-cell carcinoma. Skin cancer is the most common cancer in fair-skinned populations, and its incidence has increased steeply over recent decades. According to estimates for 2012, about 100,000 new cases of cutaneous melanoma and about 22,000 deaths from it occurred in Europe. The main mechanisms by which UVR causes cancer are well understood. Exposure during childhood appears to be particularly harmful. Exposure to UVR is a risk factor modifiable by individuals' behaviour. Excessive exposure from natural sources can be avoided by seeking shade when the sun is strongest, by wearing appropriate clothing, and by appropriately applying sunscreens if direct sunlight is unavoidable. Exposure from artificial sources can be completely avoided by not using sunbeds. Beneficial effects of sun or UVR exposure, such as for vitamin D production, can be fully achieved while still avoiding too much sun exposure and the use of sunbeds. Taking all the scientific evidence together, the recommendation of the 4th edition of the European Code Against Cancer for ultraviolet radiation is: "Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds." (C) 2015 International Agency for Research on Cancer; Licensee ELSEVIER Ltd

We demonstrate a fiber-based ultrafast source generating 450-mW, sub-100-fs pulses centered at 1250 nm by implementing self-phase modulation enabled spectral selection. This source is ideal for harmonic generation microscopy in human skin.

Conference on Lasers and Electro-Optics : [Proceedings] - OSA Washington, D.C., 2018. - ISBN 978-1-943580-42-2 - doi:10.1364/CLEO_AT.2018.AM1J.2 CLEO: Applications and Technology, CLEO AT, San Jose, California, USA, 13 May 2018 - 18 May 2018; Washington, D.C., USA : OSA, OSA technical digest (online), 2 pp. (2018). doi:10.1364/CLEO_AT.2018.AM1J.2, We demonstrate a fiber-based tunable femtosecond source covering 1.15–1.35 μm based on self-phase modulation enabled spectral selection, which allows us to optimize the excitation wavelength for harmonic generation imaging in ex vivo human skin., Published by OSA, Washington, D.C., USA

BACKGROUND UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk. OBJECTIVE To evaluate the proportion of regular sunbed use in Germany based on large-scale population-based surveys over 15 years. METHODS Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behaviour related to sunburns and sunbeds. RESULTS Among 155 679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (P

SummaryBackground Given the evidence for increased skin cancer risk due to the sunbed use, a regulation of hazardous artificial ultraviolet radiation (UVR regulation) was passed in Germany in 2012. The aim of this study was to explore the advisory services in tanning studios as reported by sunbed users and to evaluate the information provided by the personnel of tanning salons after the UVR regulation was enacted. Methods The first wave of the representative National Cancer Aid Monitoring on Sunbed Use included a subgroup of 357 German citizens between 14 and 45 years who had used sunbeds since the UVR regulation was implemented. The participants provided data on sunbed use and related issues in telephone interviews. Results Although sunbed operators are mandated to offer their customers certain services at least once since the implementation of the UVR regulation, 15.4% of sunbed users were never advised to use protective eyewear during tanning and 13.1% were not provided with eyewear during their last sunbed use. Overall, 66.0% were never offered to develop a tanning schedule, 56.9% were never advised on the risks of UVR, 43.4% were never offered a determination of their skin type and 40.0% of users were never advised on how to use a sunbed safely. Conclusions The data showed that 3 years after the UVR regulation was enacted, compliance with this legislation is still not optimal. Binding wording in the legal text and making them applicable to unsupervised sunbeds as well is necessary to extend the impact of this legislation.

Background Evidence suggests that indoor tanning may have addictive properties. However, many instruments for measuring indoor tanning addiction show poor validity and reliability. Recently, a new instrument, the Behavioral Addiction Indoor Tanning Screener (BAITS), has been developed. Objectives To test the validity and reliability of the BAITS by using a multimethod approach. Methods We used data from the first wave of the National Cancer Aid Monitoring on Sunbed Use, which included a cognitive pretest (August 2015) and a Germany-wide representative survey (October to December 2015). In the cognitive pretest 10 users of tanning beds were interviewed and 3000 individuals aged 14-45 years were included in the representative survey. Potential symptoms of indoor tanning addiction were measured using the BAITS, a brief screening survey with seven items (answer categories: yes vs. no). Criterion validity was assessed by comparing the results of BAITS with usage parameters. Additionally, we tested internal consistency and construct validity. Results A total of 19·7% of current and 1·8% of former indoor tanning users were screened positive for symptoms of a potential indoor tanning addiction. We found significant associations between usage parameters and the BAITS (criterion validity). Internal consistency (reliability) was good (Kuder-Richardson-20, 0·854). The BAITS was shown to be a homogeneous construct (construct validity). Conclusions Compared with other short instruments measuring symptoms of a potential indoor tanning addiction, the BAITS seems to be a valid and reliable tool. With its short length and the binary items the BAITS is easy to use in large surveys.

Background: Skin cancer is the most common cancer in light-skinned populations worldwide. Primary and secondary preventive activities such as skin cancer screening are intended to reduce skin cancer burden. In 2003, a population-based skin cancer screening project [SCREEN ( S kin C ancer R esearch to Provide E vidence for E ffectiveness of Screening in N orthern Germany)] was conducted in Northern Germany with more than 360 000 people screened. SCREEN was supported by a communication intervention that was aimed at informing the population about skin cancer, its risk factors and the screening intervention as well as preparing the health professionals for the project. Within SCREEN both physicians and practice nurses were educated in counselling. The aim of the present article is to describe and evaluate the communication strategy accompanying SCREEN. Methods: Two computer-assisted telephone interview surveys were performed in April/May 2003 and May 2004. Participants had to be members of the statutory health insurance and be aged ≥20 years. They were asked about knowledge of skin cancer, perception of physicians’ performance and skin cancer screening in general. Data are mainly presented in a descriptive manner. For statistical analyses, Mann–Whitney U test and Pearson’s chi-square test were used. Results: Knowledge about sunburn in childhood and high ultraviolet exposure as skin cancer risk factors increased during SCREEN. Simultaneously, the awareness for early detection of skin cancer increased significantly from 41.3 to 74.0% ( P < 0.001). A total of 21.5% of the interviewees participated in the skin cancer screening project, similar to the population-based participation rate reached. Conclusion: A comprehensive communication strategy accompanying a screening intervention improves the knowledge of potential screenees and may additionally increase the participation rate.

Summary Purpose Sunbed use, a recognized risk factor for skin cancer development, is common in developed countries. Cost-efficient interventions to reduce the negative health consequences of sunbed use are needed. As a first step to identify what kind of intervention might be useful, we aimed to assess the awareness of potential health risks of sunbed use in current, former, and never users as well as in current users with differing risk profiles. Methods We assessed risk awareness using items addressing the potential health risks of sunbed use (e.g. skin damage) in a representative sample of 4851 individuals. The response format assessed agreement with each statement. Risk profiles were defined by a large number of birthmarks, a history of frequent childhood sunburn, or a (family) history of melanoma. Results Many individuals were not aware of potential risks (e.g. agreement to skin cancer risk 72.6%). Current users were less aware compared with former and never users [e.g. skin cancer risk (65.6% vs. 75.9% and 73.0%, respectively; P