Search

Background: Dermatological health-related quality of life (HRQoL) in solid organ transplant recipients (SOTRs), often affected by skin cancer, has been insufficiently explored. This study aimed to evaluate the impact of skin cancer on quality of life (QoL) in SOTRs and to compare HRQoL measures between SOTRs with and without skin cancer. Methods: This cross-sectional study (June 2023–March 2024) assessed adult SOTRs using the Dermatology Life Quality Index (DLQI) and Skindex-29 questionnaires. For SOTRs with keratinocyte carcinoma (KC), the Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) questionnaire was also administered. Results: A total of 150 adult SOTRs were included, with 82 having developed post-transplant skin cancer, including melanoma and KCs. DLQI scores were higher in SOTRs with skin cancer, however, the difference was not statistically significant (P ≥ 0.065). SOTRs with skin cancer had higher total Skindex-29 scores (P = 0.012) and "emotion" subscale scores (P = 0.0049), indicating a negative impact on QoL. BaSQoL scores showed a moderate negative effect on QoL, with a higher number of KCs correlating with lower QoL (P < 0.05). Female gender was associated with higher DLQI and BaSQoL diagnosis and treatment scores (P < 0.05). Conclusions: SOTRs with skin cancer had lower QoL, with greater cancer burden linked to worse outcomes. Female gender was also associated with lower QoL. Tailored management strategies are crucial for this population. [ABSTRACT FROM AUTHOR]

Nonmelanoma skin cancer (NMSC) presents a significant challenge to global healthcare due to its rising incidence, prompting the search for innovative treatments to overcome the limitations of current therapies. Our study aims to explore the potential effects of the liquid blood concentrate platelet-rich fibrin (PRF) on basal cell carcinoma cells (BCCs) and squamous cell carcinoma cells (SCCs) in order to obtain results that may lead to new possible adjunctive therapies for managing localized skin cancers, particularly NMSC. Basal cell carcinoma (BCC) cells and squamous cell carcinoma (SCC) cells were indirectly treated with PRF generated via different relative centrifugation forces, namely high and low RCF PRF, for 7 days. PRF-treated cells were comparatively analyzed for cell viability, proliferation and cell cycle- and apoptosis-related gene expression. Analysis of MTS assay results revealed a significant decrease in cell viability in both BCC and SCC cells following PRF treatment for 7 days. Ki-67 staining showed a decreased percentage of Ki-67-positive cells in both BCC and SCC cells after 2 days of treatment compared to the control group. The downregulation of CCND1 gene expression in both cell types at 2 days along with the upregulation of p21 and p53 gene expression in SCC cells demonstrated the effect of PRF in inhibiting cell proliferation and inducing cell cycle arrest, especially during the initial phases of treatment. Increased expression of caspase-8 and caspase-9 was observed, indicating the activation of both extrinsic and intrinsic apoptotic pathways by PRF treatment. Although the exact immunomodulatory properties of PRF require further investigation, the results of our basic in vitro studies are promising and might provide a basis for future investigations of PRF as an adjunctive therapy for managing localized skin cancers, particularly NMSC. [ABSTRACT FROM AUTHOR]

Childhood cancer survivors (CCS) are at increased risk for keratinocyte carcinomas (KC) however, the long-term incidence of single and multiple KC is not well established. Identify risk factors and quantify KC cumulative incidence and multiple-incidence burden in CCS. KC were identified among Childhood Cancer Survivor Study participants, a cohort of 5-year cancer survivors diagnosed <21 years of age between 1970 and 1999 in North America. Cumulative incidence was estimated and multivariable models assessed relative rates of KC associated with survivor and treatment characteristics. Among 25,658 participants, 1446 developed 5363 KC (93.5% basal cell carcinoma, 6.7% squamous cell carcinoma; mean age 37.0 years (range 7.3-67.4), mean latency 25.7 years; 95.3% White and 88.4% with radiotherapy). Mean lesion count was 3.7 with 26.1% experiencing ≥4. Radiotherapy imparted a 4.5-fold increase in the rate of any KC and 9.4-fold increase in the rate of ≥4 KC. Allogeneic and autologous hematopoietic cell transplant were associated with a 3.4- and 2.3-fold increased rate of KC, respectively. Participant self-reporting of some data including race without skin phototype and past medical history may have impacted analysis. The burden of KC in CCS remains high, but predictable risk factors should guide screening. [ABSTRACT FROM AUTHOR]

Residual tumor is not always clinically apparent following biopsy of cutaneous carcinomas, which may prompt patients to question the need for definitive treatment. We investigated the percentage of cases in which residual tumor was histologically present at the time of Mohs micrographic surgery (MMS) for basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) and investigated factors associated with residual tumor. We examined 483 MMS cases performed for biopsy-proven BCC (n = 287) and SCC (n = 196) between October 2022 and April 2023. Single-stage MMS specimens were step-sectioned en face to exhaust the block. Univariate and multivariable logistic regression models were created. Residual tumor was identified in 83.3% of BCC and 66.8% of SCC at the time of MMS (P =.01). In patients clinically appearing tumor-free following biopsy, residual histologic tumor was identified in 68.2% of BCC and 41.5% of SCC. Residual tumor was significantly more likely in men (P =.04), high-risk sites (P =.002), smaller biopsy sizes (P =.0003), and larger preoperative sizes (P <.0001). Single center, retrospective cohort. The majority of patients with BCC and SCC have residual histologic tumor at the time of MMS, oftentimes even when tumor is not clinically apparent. Multiple factors impact the presence/absence of residual tumor. [ABSTRACT FROM AUTHOR]

Abstract Background Solid organ transplant recipients (SOTRs) have an increased risk of developing non melanoma skin cancers (NMSCs). The use of Imiquimod, a toll‐like‐receptor agonist, is still debated in SOTRs. Objectives The aim of this study was to evaluate efficacy and safety of topical Imiquimod in two Dermatology Centres for skin cancers in SOTRs. Methods All SOTRs with age > 18 and a dermoscopic diagnosis of superficial basal cell carcinoma (BCC) and/or actinic keratose (AK), annually followed up between January 2022 and December 2022 were screened. Results 80 NMSCs (41 BCC and 39 AK) in 66 SOTRs were identified and treated. 57 (86.4%) were male. The mean age was 66.2 years (30−85). 60 patients (90.1%) had transplanted kidney, 1 (1.5%) lung, 3 (4.5%) liver, and 1 (1.5%) heart. The average time since first transplant was 17 years (3−40 years). Tacrolimus, steroids, and mycophenolate mofetil were the most frequently used immunosuppressants (71%; 67.7%; 53.2% of cases, respectively). Responses to the first course of treatment were CR in 64.3% of cases (53.6% in AK; 67.7% in BCC); PR in 28.6% of cases (42.9% in AK; 12.9% in BCC); NR in 12.5% of cases (3.6% in AK; 19.4% in BCC). Fourteen patients received a second course of imiquimod for a persistent lesion (1 AK, 4 BCC) or a new lesion (4 AK, 5 BCC). Responses to the second course of treatment were observed in 4 (80%) and 7 (78%) cases in the persistent and new lesion, respectively (p = 0.34). No systemic adverse events were noted. The main side effects were mild: erythema, scales, and crusts, itching, or pain. Conclusions Topical imiquimod represents a viable and safe option in this category of patients. The response to imiquimod in subjects who have had more than one cycle is not related to the response to previous treatments but rather to the intrinsic characteristics of the lesion.

Abstract Background Full‐body skin examination (FSE) is fundamental to the diagnosis of cutaneous malignancy but may not always include concealed site examination (CSE). Objectives To determine the approach of international dermatologists to CSE during FSE and examine influencing factors, barriers and attitudes toward CSE. Methods Members of the International Dermoscopy Society were surveyed using an online 12‐question survey disseminated via email. Results There were 706 completed responses among 1249 unique clicks to the survey, representing a completion rate of 56.5%. Fifty‐four percent of respondents reported always examining the breasts, while 52.8%, 18.8%, and 11.8% always examined the scalp, oral, and anogenital mucosa, respectively. The most frequent reason for examining concealed sites was patient concern, whilst common reasons for not examining concealed sites included low incidence of pathology and concern regarding allegations of sexual misconduct. Conclusions Our findings allude to the need for international consensus guidelines regarding the conduct and inclusion of concealed or sensitive sites in routine FSE. This is essential to define clinician responsibilities, inform patient expectations of care, and thereby mitigate potential medicolegal repercussions.

Abstract Background Rates of keratinocyte carcinoma (KC) across Europe are impacted by population demographics and geography. Regional differences in KC occurrence exist, but few European studies investigate incidences of specific subtypes in the secondary healthcare sector on a national level. Objectives To determine geographical differences in incidence rate and lifetime risk of KC subtypes across Denmark, including nodular and superficial basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and the KC precursor, Bowen's disease (BD), identified in office‐based dermatological practice. Methods Based on a nationwide registry (The Danish Skin Cancer Registry), all patients in Denmark's five regions with a histologically‐ or clinically verified KC or BD registered in a state‐funded office‐based dermatology practice between 2013 and 2022 were included. Trends in national‐ and region‐specific age and sex standardised tumour incidence rates (STIR) were calculated. Further, national lifetime risk of each tumour subtype was estimated. Results Between 2013 and 2022, the combined STIR for KC/BD rose 172% nationally from 180 to 489 per 100,000 person‐years (PY). This increase reflected rising rates of nodular BCC, SCC, and BD, while superficial BCC incidence was relatively stable. Regional differences in STIR for combined KC/BD were observed, with the Capital Region and North Jutland generally demonstrating higher rates than Zealand, Southern‐ and Central Denmark (e.g., North Jutland vs. Southern Denmark: 714 vs. 405/100,000PY). While the estimated lifetime risk of developing at least one KC or BD tumour was 21.8%, risk varied with tumour subtype, resulting in subtype‐specific risks of 16.4%, 5.1%, 1.9% and 1.3% for nodular BCC, superficial BCC, SCC, and BD, respectively. Conclusions In Denmark's secondary dermatological care sector, incidence of nodular BCC, SCC and BD continues to rise with an overall lifetime risk nearing 22%. While KC incidence is increasing in Denmark, the study detected differences in geographical trends and rate increases of specific tumour subtypes.

Background: Janus kinase (JAK) inhibitors are promising for inflammatory bowel diseases (IBDs), but their long-term safety, including risks of nonmelanoma skin cancer (NMSC), is uncertain. Objectives: The objective of the study was to conduct a systematic review and meta-analysis to examine the risk of NMSC in patients taking JAK inhibitors for IBDs during the induction trial, maintenance trial, and long-term extension (LTE) of treatment. Methods: We searched the PubMed, Embase, and Cochrane databases to identify studies reporting NMSC with the use of JAK inhibitors. Results: In total, we retained 22 references that included 31 trials for a qualitative systematic review and 28 trials for a quantitative meta-analysis. Average risk differences were < 0.0001 (P = 0.980) in induction trials, 0.002 (P = 0.546) in maintenance trials, and 0.019 (P = 0.012) in LTE trials. Subgroup analyses showed that there were no significant differences between generic drugs, trial phases, ages, or genders. Conclusion: In patients with an IBD, there was no statistically significant difference in the risk probability of NMSC occurrence whether or not JAK inhibitors were used, regardless of the follow-up period during induction and maintenance studies. Furthermore, the overall estimated NMSC incidence rate was significantly higher than the reference incidence. Although large heterogeneity among trials, both gastroenterologists and dermatologists still should be cautious of appropriate skin screening for IBD patients using JAK inhibitors.

Simple Summary: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer that grows quickly and has a life-threatening potential. Because of its severity, it is important to provide a fast diagnostic. For a tumor like this, diagnosis usually requires a tissue sample examined under a microscope with special staining techniques. However, newer non-invasive imaging methods could help identify MCC without a biopsy. These include advanced techniques which provide detailed images of the skin. This review highlights recent research on these imaging methods, emphasizing their potential to improve MCC diagnosis and treatment planning. This can also help patients get diagnosed more quickly and comfortably, without the need for more invasive procedures. Background/Objectives: Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine malignancy characterized by its propensity for rapid growth and early regional and distant metastasis. Given its potentially lethal nature, accurate and timely diagnosis of MCC is of utmost importance. This review aims to describe non-invasive imaging methods that can serve as additional tools in the examination of MCC. Methods: In this narrative review, we describe the up-to-date spectrum of non-invasive skin-imaging methods that can serve as additional tools in the examination of MCC based on the available literature. Dermoscopy might enhance the clinical diagnosis of MCC, facilitate differentiation from other benign and malignant tumors, and help optimize the treatment plan. New imaging technologies might also provide useful information at a sub-macroscopic level and support clinical diagnosis. These techniques include high-frequency ultrasound (HFUS), reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). Results: Clinically, MCC typically presents as a rapidly growing, red, purple or skin-colored painless and firm nodule. Diagnosis is usually established with histopathological assessment and immunohistochemistry. However, dermoscopy and new imaging technologies might enhance the clinical diagnosis of MCC, facilitate differentiation from other benign and malignant tumors, and help optimize the treatment plan. [ABSTRACT FROM AUTHOR]

Background: Solar radiation is the primary risk factor for skin cancer, with personal exposure influenced by environmental and behavioral factors. At higher temperatures, behavioral changes increase solar radiation exposure. Objectives: Examine the relationships between solar radiation, ambient temperature, age, and skin cancer. Methods: For the contiguous United States, we obtained the state mean global horizontal irradiance (GHI), daily maximum temperature, and number of skin cancer removals in the Medicare population. For skin cancer removals, we defined more sun‐exposed skin as the head, neck, hands, and feet, and less sun‐exposed skin as the trunk, arms, and legs. Results: By comparing the temperature thresholds 17°C, 20°C, 24°C, 27°C, 31°C, and 34°C, we found that the annual number of days above 24°C was the strongest temperature‐related predictor of skin cancer removals. Multivariable linear regression showed that the number of days above 24°C predicted more skin cancer removals for all body locations and less sun‐exposed skin (p = 0.008 and p = 0.003, respectively), while GHI did not (p = 0.1 and p = 0.8, respectively). GHI only predicted more skin cancer removals for more sun‐exposed skin (p = 0.02). Conclusion: More days above 24°C was a better predictor of skin cancer removals than GHI for all skin locations and less sun‐exposed skin, suggesting that the behavioral changes occurring at warmer temperatures are more predictive of skin cancer removals than solar irradiance. Due to rising global temperatures, skin cancer incidence may further increase. Temperature‐related behavioral changes represent a potential target for skin cancer prevention efforts. [ABSTRACT FROM AUTHOR]

Photodynamic therapy (PDT) is a nonscarring cancer treatment in which a pro‐drug (5‐aminolevulinic acid, ALA) is applied, converted into a photosensitizer (protoporphyrin IX, PpIX) which is then activated by visible light. ALA‐PDT is now popular for treating nonmelanoma skin cancer (NMSC), but can be ineffective for larger skin tumors, mainly due to inadequate production of PpIX. Work over the past two decades has shown that differentiation‐promoting agents, including methotrexate (MTX), 5‐fluorouracil (5FU) and vitamin D (Vit D) can be combined with ALA‐PDT as neoadjuvants to promote tumor‐specific accumulation of PpIX, enhance tumor‐selective cell death, and improve therapeutic outcome. In this review, we provide a historical perspective of how the combinations of differentiation‐promoting agents with PDT (cPDT) evolved, including Initial discoveries, biochemical and molecular mechanisms, and clinical translation for the treatment of NMSCs. For added context, we also compare the differentiation‐promoting neoadjuvants with some other clinical PDT combinations such as surgery, laser ablation, iron‐chelating agents (CP94), and immunomodulators that do not induce differentiation. Although this review focuses mainly on the application of cPDT for NMSCs, the concepts and findings described here may be more broadly applicable towards improving the therapeutic outcomes of PDT treatment for other types of cancers. [ABSTRACT FROM AUTHOR]

Nonmelanoma skin cancer (NMSC) represents the most prevalent form of skin cancer globally, with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) being the most common types. The search for effective chemopreventive and therapeutic agents has led to the exploration of natural compounds, among which resveratrol (RES), a polyphenolic phytoalexin found in grapes, berries, peanuts, and red wine, has garnered significant attention. This comprehensive review aims to elucidate the effects of RES on NMSC, focusing on its mechanisms of action, efficacy in preclinical studies, and potential as a chemopreventive and therapeutic agent. RES exhibits promising chemopreventive and antineoplastic capabilities against NMSC through various mechanisms, including the induction of apoptosis, inhibition of cell proliferation, modulation of oxidative stress, and anti‐inflammatory activities. Studies have demonstrated that RES can significantly enhance the effectiveness of traditional chemotherapeutic agents, such as 5‐fluorouracil (5‐FU), by inhibiting cellular proliferation and inducing apoptosis in cancerous cells. Furthermore, resveratrol's antioxidant properties may mitigate the impact of reactive oxygen species (ROS) triggered by UV exposure, thus reducing DNA damage and mutations associated with skin cancer development. In vitro and in vivo experiments have shown that RES can effectively hinder the growth and spread of various tumor cell types, including human cutaneous SCC A431 cells, and induce apoptosis. The development of advanced delivery systems, such as nanostructured lipid carriers and liposomes, has been recognized for their potential to enhance the therapeutic effects of RES, particularly its anticancer properties. In conclusion, RES presents a viable candidate for the prevention and treatment of NMSC, owing to its multifaceted mechanisms of action, including its ability to regulate oxidative stress, trigger apoptosis, and inhibit proliferation. However, further clinical studies are required to fully understand its effectiveness and safety in humans, as well as to optimize delivery methods for improved bioavailability and therapeutic outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND Hypertension affects 25%–30% of the world population. Hydrochlorothiazide (HCTZ) is among the most used and cheapest medications but was in 2018 labeled with a warning stating the increased risk of nonmelanoma skin cancer (NMSC). This study describes geographical differences in the association between HCTZ and NMSC from the perspective of hypertensive heart disease (HHD). METHODS We conducted a systematic literature search (PubMed, Embase, Clinicaltrial.gov, and Clinicaltrial.eu) using PICO/PECO acronyms, including case–control, cohort, and randomized controlled trials. We constructed a rate ratio of disability-adjusted life years (DALY) for HHD/NMSC in the global burden of disease (GBD) regions. RESULTS No increased risk of NMSC with the use of HCTZ was found in Taiwan, India, and Brazil. A small (hazard ratio (HR)/odds ratio (OR) ≤1.5) but significantly increased risk was seen in Canada, the United States, and Korea. An increased risk (1.5< HR/OR ≤2.5) in Iceland, Spain, and Japan and a highly increased risk (HR/OR >2.5) in the United Kingdom, Denmark, the Netherlands, and Australia. HHD is associated with a more than tenfold DALY rate compared with NMSC in 13 of 21 GBD regions, corresponding to 77.2% of the global population. In none of these 13 regions was there an increased risk of HCTZ-associated NMSC. CONCLUSIONS Despite limited information from many countries, our data point to large geographical differences in the association between HCTZ and NMSC. In all GBD regions, except Australasia, HHD constitutes a more than fivefold DALY rate compared to NMSC. This disproportionate risk should be considered before avoiding HCTZ from the antihypertensive treatment. [ABSTRACT FROM AUTHOR]

Objective: We sought to examine possible differences in BCC characteristics and treatment patterns between two matched cohorts of Hispanic White and non-Hispanic White individuals. Methods: In this single institution, retrospective matched cohort study, data from patients with biopsy proven BCC from June 2005 to May 2022 was collected. Demographic, BCC, and treatment characteristics were compared between Hispanic White and non-Hispanic White individuals using a Wilcoxon rank-sum test, for continuous and ordinal variables, and Fisher's exact test, for categorical variables. Results: A total of 604 individuals with a diagnosis of biopsy-proven BCC were matched in a 1:1 fashion by age (± 0 years) and sex, based on self-identified ethnicity as Hispanic or non-Hispanic. Since all patients self-identified as White race, the two cohorts were labeled Hispanic White (n=302) and non-Hispanic White (n=302). The most frequent location for BCC was in the H area, 129 [42.7%] White Hispanic group vs 132 [43.7%] White non-Hispanic group (p = 0.87). In both Hispanic White and non-Hispanic White groups, the predominant subtype of BCC was the nodular (149 [50.2%] vs 164 [54.7%], p = 0.25). The median BCC pre-operative size in the Hispanic White group was 0.9 cm, whereas in the non-Hispanic White group, it was 1.0 cm (p = 0.004). Furthermore, the MMS defect size in the Hispanic White group had a median of 1.3 cm, while in the non-Hispanic White group, it was 1.6 cm (p < 0.001). Limitations: Retrospective design, single-center study, and self-reported race and ethnicity. Conclusion: Both groups had similar demographics, tumor features, treatments, and post-operative complications. Notably, preoperative lesion and MMS defect sizes were larger in non-Hispanic Whites than in Hispanic Whites, contrary to expectations. Despite assumptions of poorer skin cancer outcomes among Hispanics, our findings indicate increased sizes in non-Hispanic Whites. Given the diversity in genetics and clinical traits within ethnicities, especially Hispanics, more research is needed for precise insights into disease outcomes across diverse backgrounds. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to describe risk factors and recurrence patterns that can guide the creation of evidence‐based surveillance guidelines for advanced cutaneous squamous cell carcinoma of the head and neck. Study Design: This was a single‐institution retrospective case series. Setting: High‐volume academic head and neck surgical oncology practice. Methods: Patients who underwent surgery for cutaneous squamous cell carcinoma of the head and neck staged Brigham and Women's Hospital T2b and T3 from 2003 to 2023 were reviewed. Patient demographics, clinicopathologic history, cancer data, treatment, and outcomes were abstracted. Disease‐free survival and risk factors for recurrence were described. Results: A total of 183 patients were included. Fifty‐six (30.6%) experienced recurrence. This included local recurrence in 21 (11.5%), regional in 21 (13.3%), and distant in 11 (6%). The majority of regional and distant recurrences occurred within 1 year of surgery. Conclusion: The majority of disease recurrence occurs in the first 1 to 2 years following surgical excision of advanced‐stage cutaneous squamous cell carcinoma of the head and neck. Close surveillance and frequent imaging within those years are critical to catch subclinical and distant diseases. [ABSTRACT FROM AUTHOR]

Background: Basal cell carcinoma is the most common nonmelanoma skin cancer, followed by cutaneous squamous cell carcinoma. The objective of the current study was to retrospectively evaluate the epidemiology, characteristic variations, histological aspects, and prognosis of basal cell carcinoma of the facial region based on a single-centre experience. Methods: Data from 125 patients admitted to the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, for surgical treatment of basal cell carcinomas of the face between January 2015 and April 2021 were evaluated. Results: The mean patient age was 79.58 years, 60.5% were male and 39.5% were female. Six patients (4.8%) had tumour recurrence with no regional metastasis. Seventy-nine patients (63%) were classified as T1. The nose and the temporal region were the most common areas. The mean tumour thickness was 3.20 mm. Conclusions: Micronodular, sclerosing/morphoeic, nodular, and superficial growth patterns of basal cell carcinoma are highly correlated to recurrence, so an excision safety margin is recommended. There is a strong correlation between tumour thickness and recurrence among basal cell carcinoma cases. When completely excised, the recurrence rate for basal cell carcinoma is relatively low. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about prognostic factors that may influence the response to non-invasive treatments of patients with Bowen's disease. The aim of this study was to identify patient and lesion characteristics that are associated with a higher risk of treatment failure after 5-fluorouracil and photodynamic therapy in Bowen's disease. The hypothesis that the thickness of the Bowen's lesion and extension along the hair follicle is associated with the risk of treatment failure after noninvasive treatment was also explored. Methods: Data were derived from a non-inferiority randomized trial in which 169 patients were treated with 5% 5-fluorouracil cream twice daily for 4 weeks or 2 sessions of methylaminolevulinate photodynamic therapy with 1-week interval. All patients had histologically confirmed Bowen's disease of 4–40 mm. The initial 3 mm biopsy specimens were re-examined to measure the maximum histological lesion thickness and extension along the hair follicle. To evaluate the association between potential risk factors for treatment failure at 1-year follow-up, univariate and multivariate logistic regression analyses were used to calculate odds ratios (ORs) with 95% confidence intervals and p values. Results: Histological lesion thickness was not significantly associated with treatment failure (OR: 0.84, p = 0.806), nor was involvement of the hair follicle (OR: 1.12, p = 0.813). Lesion diameter was the only risk factor that was significantly associated with 1-year risk of treatment failure (OR = 1.08 per mm increase, p = 0.021). When using the median value of 10 mm as cut-off point, the risk of treatment failure was 23.4% for lesions >10 mm compared to 10.3% for lesions ≤10 mm (OR: 2.66, p = 0.028). Conclusions: Only clinical lesion diameter was identified as a prognostic factor for response to non-invasive therapy in Bowen's disease. [ABSTRACT FROM AUTHOR]

ObjectiveNonmelanoma skin cancer (NMSC) is a common malignancy that starts in the top layer of the skin. Exposure to heavy metals has been suggested to increase the risk of skin cancer. Cadmium, prevalent in various industries and present in cigarette smoke, has been implicated in potential skin effects in animal studies. However, the impact of chronic cadmium exposure on NMSC development remains largely unexplored. This study aimed to investigate the relationship between blood cadmium levels and the odds of NMSC.MethodsWe analyzed cross-sectional data from the National Health and Nutrition Examination Survey, covering the years 1999–2000 to 2017–2018. NMSC cases were identified through self-reported physician diagnoses. We assessed the association between blood cadmium levels—considered as both a continuous variable and in quartiles—and the odds of NMSC using multivariable logistic regression models. Restricted cubic splines (RCS) were incorporated to estimate the non-linear relationship between cadmium levels and NMSC.ResultsThe study included 41,577 participants, with 952 reporting NMSC and 40,625 without any cancers. No association was found between cadmium levels and NMSC when analyzed as either a continuous or quartile variable. However, RCS revealed an inverted U-shaped curve indicating a relationship between blood cadmium levels and NMSC odds. This pattern persisted when focusing exclusively on non-Hispanic White participants.ConclusionA statistically significant relationship was observed between blood cadmium levels and the odds of NMSC, though the increased odds were only evident at low cadmium levels. Further research is necessary to investigate the causality and underlying mechanisms involved.

Abstract Background Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) can yield improved diagnostic accuracy of nonmelanoma skin cancer (NMSC) in comparison with dermoscopy alone. Objectives The aim of this study was to compare the diagnostic performance of OCT and RCM together and individually with that of dermoscopy. Methods Patients with lesions suspicious for NMSC were randomized into two groups in a prospective, single‐centre study. In the intervention group (IG), every lesion was examined with dermoscopy, OCT and RCM, while in the control group (CG), every lesion was examined with dermoscopy alone. Results A total of 365 lesions of 250 patients (105 female, 145 male) were included in the study. A total of 208 basal cell carcinomas (BCCs), 65 squamous cell carcinomas (SCCs) and 31 SCCs in situ were examined histologically. The IG involved significantly fewer biopsies than the CG (14 vs. 27, p = 0.029) and required fewer additional inpatient stays due to positive biopsy results (2 vs. 12, p = 0.001). For the diagnosis of BCC, diagnostic accuracy was 81% with dermoscopy, 84% with OCT, 83% with RCM and 85% with the combination of OCT and RCM (OCT/RCM). The diagnostic accuracy of OCT for BCC subtypes was as follows: superficial, 89%; nodular, 79%; sclerodermiform, 82%; and nodular‐cystic BCC, 75%. For the diagnosis of SCC, diagnostic accuracy was 85% with dermoscopy, 87% with OCT, 89% with RCM and 87% with OCT/RCM. For the diagnosis of in situ SCC, diagnostic accuracy was 87% with dermoscopy, 89% with OCT, 89% with RCM and 91% with OCT/RCM. Conclusions Diagnostic accuracy increased with OCT and RCM and was even higher when both methods were used together. OCT and RCM could facilitate optimization of lesion management by reducing the number of punch biopsies and reducing additional inpatient stays due to positive biopsy results.

Introduction: Grenz ray therapy popular in dermatology decades ago causes multiple and recalcitrant skin cancer in the treated field many years later. The treatment of choice is surgical excision, but limitations especially disfiguring scarring are a major challenge. We introduce 20 MHz high-intensity focused ultrasound (HIFU) as a new therapy overcoming the limitations of excisional surgery. Case Presentation: A 66-year-old female, who in the 1980s had received several grenz ray treatments of the scalp, developed multiple basal cell carcinomas in the field. She had over 30 excisional surgeries including Mohs surgery in the past with many local complications but, nevertheless, recurrent cancers. HIFU treatments applied to eight basal cell carcinomas and two precancerous lesions resulted in complete clearing at 12-month control, but one recurrence after 15 months. Conclusion: The HIFU treatment is convenient, with very few complications, and applicable to field eradication of skin premalignancies and malignancies. HIFU may fill out a hitherto unmet need of both preventive and curative treatment with better long-term control of patients with recalcitrant skin cancer after grenz ray given in the past. HIFU is a new potentially important therapeutic modality in skin oncology, combining curative treatment, field eradication, and prevention in one procedure through treatment of lesions in different states of progression.

Background: Janus kinase (JAK) inhibitors are promising for inflammatory bowel diseases (IBDs), but their long-term safety, including risks of nonmelanoma skin cancer (NMSC), is uncertain. Objectives: The objective of the study was to conduct a systematic review and meta-analysis to examine the risk of NMSC in patients taking JAK inhibitors for IBDs during the induction trial, maintenance trial, and long-term extension (LTE) of treatment. Methods: We searched the PubMed, Embase, and Cochrane databases to identify studies reporting NMSC with the use of JAK inhibitors. Results: In total, we retained 22 references that included 31 trials for a qualitative systematic review and 28 trials for a quantitative meta-analysis. Average risk differences were < 0.0001 (P = 0.980) in induction trials, 0.002 (P = 0.546) in maintenance trials, and 0.019 (P = 0.012) in LTE trials. Subgroup analyses showed that there were no significant differences between generic drugs, trial phases, ages, or genders. Conclusion: In patients with an IBD, there was no statistically significant difference in the risk probability of NMSC occurrence whether or not JAK inhibitors were used, regardless of the follow-up period during induction and maintenance studies. Furthermore, the overall estimated NMSC incidence rate was significantly higher than the reference incidence. Although large heterogeneity among trials, both gastroenterologists and dermatologists still should be cautious of appropriate skin screening for IBD patients using JAK inhibitors. [ABSTRACT FROM AUTHOR]

Background: Nonmelanoma skin cancer (NMSC) is the most common malignancy affecting Caucasian populations and has been seeing steady increases in incidence globally for decades. Our previous study (from Alberta, Canada) had shown a plateau in the incidence rates for NMSC. This contrasts with data from other regions within Canada and throughout the world that indicated a continued increase in incidence rates of NMSCs. Objectives: The objective of this study was to provide an update on the trends in incidence of NMSC in Alberta, Canada, from 2007 to 2018. Methods: A retrospective analysis of patients from Alberta diagnosed with NMSC from 2007 to 2018 inclusive was conducted with data retrieved from Alberta Cancer Registry. Sex-, age-, anatomical location-, NMSC subtype-, stage-specific incidence rates and trends were examined. Results: From 2007 to 2018, overall incidence rates of NMSC increased by 36%. Invasive squamous cell carcinoma (SCC) and in situ SCC demonstrated the most significant increase, invasive SCC [annual percentage change (APC) 3.48, P =.014] and in situ SCC (APC 5.61, P =.0001). In addition, we were able to determine that females had the most significant increases in NMSC incidence rates from 2007 to 2018 particularly invasive SCC (APC 3.03, P = <.0001) and in situ SCC (APC 5.08, P = <.0001). Conclusions: After initial levelling of NMSC incidence in Alberta in the early part of 21st century, the incidence of NMSC continues to increase over the past decade. The reasons for this change are not clear and likely multifactorial. [ABSTRACT FROM AUTHOR]

Simple Summary: The study examined the number of deaths from nonmelanoma skin cancer (NMSC) in Australia for the fifty years from 1971 to 2021. Australia has the highest reported incidences of NMSC in the world. Deaths from NMSC have been recorded since 1971 and have increased more than five-fold in the 50 years to 2021. There is no sign of a reduction in the increasing incidence of deaths from NMSC. Most deaths from NMSC are due to cutaneous squamous cell carcinoma (SCC). It is estimated that 1 in 260 cutaneous SCCs will metastasize and cause death. The number of non-melanoma skin cancers (NMSC) removed from Australians is increasing every year. The number of deaths from NMSC is increasing but so is the population. However, the population has greatly changed with many dark-skinned people migrating to Australia. These people are at low risk for skin cancer even if they live all their lives in Australia. The susceptible population is the rest of the population. The death rate from NMSC for the entire population and susceptible populations since 1971 is examined in this article. Materials and methods: Data on the Australian population were obtained from the Australian Bureau of Statistics (ABS). Every five years a census is held in Australia and detailed information of the population is provided. The ABS also provided yearly data on the causes of death in Australia. Results: The total population increased from 12,755,638 in 1971 to 25,738,140 in 2021. However, the susceptible population increased by far less, from 12,493,780 to 19,773,783. The number of deaths from NMSC increased from 143 to 765. The crude death rate for the susceptible population increased from 1.1 per 100,000 to 3.9 per 100,000. The crude death rate in the susceptible population aged 65 or more increased from 9.4 to 18.2 per 100,000. Conclusion: Deaths from NMSC are increasing despite public health campaigns to prevent skin cancer. According to current trends, NMSC will cause more deaths than melanoma in Australia. [ABSTRACT FROM AUTHOR]

Objective: One in every three diagnosed malignancies is skin cancer, making it the most prevalent type of cancer in the world. As skin cancer is not commonly reported in Kuwait, this study was conducted to analyze the clinicopathological characteristics of nonmelanoma skin cancers (NMSC), primarily basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), during the last 13 years in a tertiary dermatology center in Kuwait. Materials and Methods: Data were searched for patients with NMSC, primarily BCC and SCC, from 2010 to 2022. A retrospective review was conducted and descriptive data analysis was performed. Results: Of 7,645 cases, a total of 146 patients had NMSC. The patient's average age was 64.9 years. 123 cases (84.2%) had BCC, whereas 23 (15.8%) had SCC. Most of the tumors were seen on the face (35.6%), scalp (20.8%), and nose (17.8%), followed by the back (6.2%), trunk (5.5%), and ear (5.5%). Well-differentiated Cutaneous SCCs were detected in 82.6% of cases. Ulceration was observed in (21.9%) of tumors. The nodular BCC subtype was observed in 50.4% of patients. Conclusion: BCC is the most common type of NMSC detected in Kuwait, with the scalp and face being the most common sites of involvement. Any suspicious lesions should be biopsied to rule out skin malignancy. Highlights of the Study: This is a retrospective and descriptive study that highlights the clinicopathological characteristics of nonmelanoma skin cancer (NMSC) in Kuwait. Most of the tumors were seen on the face and scalp. Traditional clothes worn by men which cover the head and neck regions represent a protective factor from NMSC. [ABSTRACT FROM AUTHOR]

Background/aimIt is estimated that nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), affects more than 3 million Americans each year. Translation of next-generation sequencing (NGS) data into identification of new potential targets for therapeutic applications may be helpful. Whole-exome sequencing (WES) is a widely used NGS method that involves sequencing the protein-coding regions of the genome.Case reportWe report a case of a 65-year-old female smoker who was found to have two 6 mm lesions in her left nasal vestibule. Biopsies demonstrated synchronous BCC and SCC. The patient underwent surgical excision of both cancers with safe margins followed by plastic reconstruction. WES was performed on both cancers and 16 alterations including BRCA2 (p.P389S), FAM5C (S420L), KMT2A (P855L), and SMO (L412F), as unique for BCC, and 4 alterations including TP53 (p.H179Q) and CDKN2A (p.P114L), as unique for SCC, were identified.ConclusionWe report the first documented case with unique genetic alterations in two distinct and synchronous skin BCC and SCC arising from the same nasal vestibule of a patient. This adds to the growing field of data regarding genetic variants in characterizing malignancies and potentially for targeted therapies.

Simple Summary: Artificial intelligence (AI) has shown promise in detecting and diagnosing nonmelanoma skin cancer through image analysis. The incidence of skin cancer continues to rise each year, and it is estimated that one in five Americans will have nonmelanoma skin cancer at some point in their lifetime. Non-invasive diagnostic tools are becoming more widely adopted as the standard of care. When integrated with AI, there is the potential to identify skin cancer earlier and more rapidly compared to traditional methods. This review aims to assess the current status of AI diagnostic algorithms in tandem with noninvasive imaging for the detection of nonmelanoma skin cancer. Background: The objective of this study is to systematically analyze the current state of the literature regarding novel artificial intelligence (AI) machine learning models utilized in non-invasive imaging for the early detection of nonmelanoma skin cancers. Furthermore, we aimed to assess their potential clinical relevance by evaluating the accuracy, sensitivity, and specificity of each algorithm and assessing for the risk of bias. Methods: Two reviewers screened the MEDLINE, Cochrane, PubMed, and Embase databases for peer-reviewed studies that focused on AI-based skin cancer classification involving nonmelanoma skin cancers and were published between 2018 and 2023. The search terms included skin neoplasms, nonmelanoma, basal-cell carcinoma, squamous-cell carcinoma, diagnostic techniques and procedures, artificial intelligence, algorithms, computer systems, dermoscopy, reflectance confocal microscopy, and optical coherence tomography. Based on the search results, only studies that directly answered the review objectives were included and the efficacy measures for each were recorded. A QUADAS-2 risk assessment for bias in included studies was then conducted. Results: A total of 44 studies were included in our review; 40 utilizing dermoscopy, 3 using reflectance confocal microscopy (RCM), and 1 for hyperspectral epidermal imaging (HEI). The average accuracy of AI algorithms applied to all imaging modalities combined was 86.80%, with the same average for dermoscopy. Only one of the three studies applying AI to RCM measured accuracy, with a result of 87%. Accuracy was not measured in regard to AI based HEI interpretation. Conclusion: AI algorithms exhibited an overall favorable performance in the diagnosis of nonmelanoma skin cancer via noninvasive imaging techniques. Ultimately, further research is needed to isolate pooled diagnostic accuracy for nonmelanoma skin cancers as many testing datasets also include melanoma and other pigmented lesions. [ABSTRACT FROM AUTHOR]

Sebaceous carcinoma (SC) is a very rare and aggressive form of skin cancer that arises from the sebaceous glands. SC can occur anywhere on the body, but most commonly affects the head and neck, especially the upper eyelid. SC is the third most common malignancy of the eyelid and has the potential to metastasize and be fatal; therefore, it is vital for dermatologists to remain acquainted with this malignancy and its most current treatment options. Most commonly presenting as a painless lump or thickening of skin on the eyelid, SC has an insidious progression that may not prompt the patient to seek medical attention immediately. To avoid the potential of metastasis, early diagnosis and treatment is paramount. To assess if the cancer has spread, ophthalmology, imaging, and sentinel lymph node biopsy are recommended. This article provides a comprehensive review of SC’s pathogenesis, current diagnostic methods, and treatments, including wide local excision, Mohs micrographic surgery, orbital exenteration, radiation, and other topicals. The prognosis of SC depends on several factors, including size, location, stage, and treatment method. After treatment of the neoplasm, diligent post-treatment surveillance remains the cornerstone of patient care. Continued dermatologic follow-ups are essential for early detection of reoccurrence, ensuring timely intervention and optimal long-term outcomes. In conclusion, this comprehensive review aims to equip dermatologists and other physicians with a nuanced understanding of SC, enabling them to provide effective care to support patients encountering this malignancy. [ABSTRACT FROM AUTHOR]

Introduction Treatments for nonmelanoma skin cancer (NMSC) include excision (surgical removal) and destruction (cryotherapy or curettage with or without electrodesiccation) in addition to other methods. Although cure rates are similar between excision and destruction for low-risk NMSCs, excision is substantially more expensive. Performing destruction when appropriate can reduce costs while providing comparable cure rate and cosmesis. Objective To identify characteristics associated with exclusive (outlier) performance of excision or destruction for NMSC. Methods The study consisted of malignant excision and destruction procedures submitted by dermatologists to Medicare in 2019. Proportions of services for each method were analyzed with respect to geographic region, years of dermatology experience, median income of the practice zip code, and rural-urban commuting area (RUCA) code. Results Fewer years of experience predicted a higher proportion of excisions (R2 = 0.7, p < .001) and higher odds of outlier excision performance. Outlier performance of excision was associated with practicing in the South, Midwest, and West, whereas outlier performance of destruction was associated with practicing in the Northeast and Midwest. Conclusions Dermatologists with less experience or in certain geographic regions performed more malignant excision relative to destruction. As the older population of dermatologists retires, the cost of care for NMSC may increase.

Heart transplant recipients experience high rates of skin cancer, likely due to greater length or dosage of immunosuppression. We review the impact of immunosuppressive medications on development of nonmelanoma skin cancer (NMSC) in heart transplant recipients. The authors searched keywords "heart transplant" and "nonmelanoma skin cancer" on PubMed in October 2022 for eligible articles available in English. Articles were selected for inclusion based on relevance to heart transplantation and NMSC. If any cited articles within included articles were related to our search they were also included. Of the 29 identified articles, 18 met the inclusion criteria with a total of 11,699 patients. Two studies found that tacrolimus and azathioprine increased the risk of NMSC. Five studies demonstrated that tacrolimus, everolimus, sirolimus, azathioprine and mycophenolate mofetil decreased the risk of NMSC. Three studies described that cyclosporine, tacrolimus, everolimus, sirolimus, azathioprine, mycophenolate mofetil and prednisone had no significant association with the development in NMSC. Two studies did not specify the correlation between immunosuppressant use and NMSC development. Ten studies did not discuss the association of immunosuppressants use with the development of NMSC. Our review highlights the commonly used immunosuppressive drugs that can impact the development of NMSC in heart transplant recipients. A management strategy in immunosuppression-associated skin cancers may ultimately involve adjusting the immunosuppressive regimen. This review serves as a summary of the most commonly used immunosuppressive drugs in heart transplant patients and their tumorigenic mechanisms to guide recommendations for dermatologic follow-up in heart transplant recipients. [ABSTRACT FROM AUTHOR]