Journal of Skin Cancer最新文献

Point mutations at codon 600 of the BRAF oncogene are the most common alterations in cutaneous melanoma (CM). Assessment of BRAF status allows to personalize patient management, though the affordability of molecular testing is limited in some countries. This study aimed to develop a model for predicting alteration in BRAF based on routinely available clinical and histological data. Methods: For identifying the key factors associated with point mutations in BRAF, 2041 patients with CM were recruited in the study. The presence of BRAF mutations was an endpoint. The variables included demographic data (gender and age), anatomic location, stage, histological subtype, number of mitosis, and also such features as ulceration, Clark level, Breslow thickness, infiltration by lymphocytes, invasiveness, regression, microsatellites, and association with nevi. Results: A relatively high rate of BRAF mutation was revealed in the Ukrainian cohort of patients with CM. BRAF-mutant melanoma was associated with younger age and location of nonsun-exposed skin. Besides, sex-specific differences were found between CM of various anatomic distributions and the frequency of distinct BRAF mutation subtypes. A minimal set of variables linked to BRAF mutations, defined by the genetic input selection algorithm, included patient age, primary tumor location, histological type, lymphovascular invasion, ulceration, and association with nevi. To encounter nonlinear links, neural network modeling was applied resulting in a multilayer perceptron (MLP) with one hidden layer. Its architecture included four neurons with a logistic activation function. The AUROCMLP6 of the MLP model comprised 0.79 (95% CІ: 0.74-0.84). Under the optimal threshold, the model demonstrated the following parameters: sensitivity: 89.4% (95% CІ: 84.5%-93.1%), specificity: 50.7% (95% CІ: 42.2%-59.1%), positive predictive value: 73.1% (95% CІ: 69.6%-76.3%), and negative predictive value: 76.0% (95% CІ: 67.6%-82.8%). The developed MLP model enables the prediction of the mutation in BRAF oncogene in CM, alleviating decisions on personalized management of patients with CM. In conclusion, the developed MLP model, which relies on the assessment of 6 variables, can predict the BRAF mutation status in patients with CM, supporting decisions on patient management.

Skin cancer is the most common cancer worldwide. According to the Skin Cancer Foundation, Mohs micrographic surgery (MMS) is considered the most effective technique for treating nonmelanoma skin cancer (NMSC). Recurrence rate after MMS for treating NMSC ranges from 1.4% to 3.2% for primary tumors and 2.4%-6% for recurrent tumors. The aim of the study was to report data from a tertiary care center in Lebanon providing MMS to patients with NMSC. Retrospective cohort study was conducted through chart review of 94 patients at the Lebanese American University Medical Center (LAUMC-RH) with a total of 115 cases of MMS identified. The study showed that most cases were males (72; 63%), and 77% were aged > 60 years (88). The average tumor size was 1.6 cm. Recurrence rate was zero in primary tumors and 0.9% in recurrent tumors. With respect to age, bivariate analysis showed that cases of males over 60 years of age were more significantly associated with undergoing Mohs surgery (69% vs. 31%; p=0.012). With respect to maximum tumor diameter (MTD) > 1 cm, male gender was associated with a higher MTD when compared to females (74% vs. 26%; p=0.02). Also, Area L was associated with a larger MTD when compared to areas H and M, respectively (90% vs. 61.1% vs. 37.7%; p=0.01). Multivariate analysis of MTD showed that tumors with MTD > 1 cm were significantly associated with male gender, presence in low- or middle-risk areas and being a recurrent tumor. This study shows that MMS is adequate for the treatment of NMSC at our center with minimal complications (< 1%) and recurrence (< 1%).

Objective: The primary aims of the study were to (1) explore the association of skin cancer and four ultraviolet radiation (UVR) indicators (sunbed use, healthcare data on diagnosed melanocytic nevi (MN) and actinic keratosis (AK), and latitude of birthplace), and (2) find factors other than UVR that could explain the increasing trend in incidence of skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and cutaneous malignant melanoma (CMM).

Methods: This population-based cohort study used self-reported questionnaire data from the Stockholm Public Health Cohort, encompassing 103 questions, merged with data from Swedish national registers. The study population included almost 35,000 Swedish-born people aged 30-66 years in 2014. Binomial logistic regression was employed for analysis. A forward stepwise regression was applied to select significant risk factors among all the factors included. We tentatively tested >30 variables separately for any relationship with each of the three skin cancers. A 5% level of significance was applied. Melanoma in situ and SCC in situ were excluded.

Results: The four UVR-related factors (sunbed use, being diagnosed with AK or MN, birthplace latitude) had a significant association with at least one of the three skin cancers that remained after adjustment including behavioural, social, hereditary, and medical factors. Sunbed use >10 times before age 30 years was related to all three skin cancers; SCC adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) 1.12-2.47, CMM (aOR 1.57, 95% CI 1.11-2.22), and the clearest dose-response association with BCC (aOR 1.74, 95% CI 1.46-2.06). None of the examined lifestyle factors, except physical activity, had any significant associations with UVR indicators or skin cancer.

Conclusion: We did not find any preventable explanatory cause other than UVR exposure for the increasing incidence of skin cancers. This result remained when adjusting for an array of possible confounders including behavioural, social, hereditary, and medical factors.

Melanoma in challenging anatomical locations such as the face, acral surfaces, and mucosal areas presents unique hurdles for surgical excision. This review examines alternative nonsurgical treatment modalities in the context of these complexities, addressing the gaps in current guidelines and the varied efficacy of existing therapies. A comprehensive literature search was conducted using PubMed, Embase, and Web of Science databases. The review focuses on peer-reviewed articles discussing nonsurgical treatment options for melanoma in complex anatomical locations. Articles were screened by three independent researchers, ensuring a broad analysis of topical agents, immunotherapies, radiotherapies, and targeted therapies. The review highlights significant advancements in localized treatments such as imiquimod and intralesional therapy with talimogene laherparepvec (T-VEC), which show promise in managing nonexcisable melanomas. BRAF and MEK inhibitors, as well as checkpoint inhibitors targeting CTLA-4 and PD-1/PD-L1 pathways, demonstrate improved survival rates but pose challenges with resistance and systemic side effects. Radiotherapy serves as an adjunctive strategy due to melanoma's inherent radioresistant properties. Despite advancements, there is a notable absence of comprehensive, evidence-based protocols to guide the treatment of melanoma in these critical areas. This paper underscores the need for standardized treatment guidelines that account for the efficacy, side effects, and psychosocial impacts of therapies. Future research should focus on refining existing treatments and exploring innovative modalities to enhance patient outcomes in the management of nonexcisable melanomas. Comprehensive guidelines and long-term efficacy studies are essential to optimize care and improve the quality of life for patients afflicted with melanoma in challenging anatomical locations.

This cross-sectional study assessed the knowledge, attitude, and practices (KAP) regarding skin cancer among dermatology clinic patients, medical students, and general practitioners (GPs) in Tehran, Iran. The researchers collected data using a validated questionnaire administered online, measuring KAP on scales of 0-31, 0-16, and 0-28, respectively, with scores above 16, 8, and 14 indicating "good" levels. Of 2243 participants (mean age 28 years), 59.4% had good knowledge, 19.8% had good attitudes, 31.8% had good practices, and 29.8% had good overall KAP. Medical students/GPs scored higher on knowledge and attitudes, while patients scored better on practices. Knowledge, attitudes, and practices were positively correlated in professionals but inversely correlated in patients. The findings suggest that while knowledge was moderate, attitudes and behaviors remained poor, particularly among patients. Immediate interventions are needed to improve attitudes and prevention practices, as public health initiatives must focus on positively influencing both to translate knowledge into meaningful action and find the reasons why good knowledge may not always lead to good practice. These findings underline the need for targeted interventions to bridge the gap between knowledge and preventive behaviors, to effectively reduce the burden of skin cancer in the population.

Background: Patients with field cancerization will develop numerous superficial non-melanoma skin cancers (NMSCs). Treating patients with field cancerization can be challenging and burdensome due to the numerous non-melanoma skin cancers (NMSCs) they develop and the frequent dermatology visits required for biopsy and treatment.

Objective: The success rate of diagnosing and treating lesions suspicious for NMSCs on the same day is measured, immediately after biopsy.

Methods: We retrospectively reviewed records of patients with same day lesion diagnosis and curettage treatment to determine diagnostic accuracy, treatment failure, and number needed to treat to reduce a follow-up treatment.

Results: A total of 237 lesions underwent same day biopsy and treatment, of which the majority were NMSC (66%) or actinic keratosis (23%). Patients had at least 3 months and a median of 17 months follow-up. A total of 20 lesions either recurred or were deemed to require additional treatment. The number needed to treat (NNT) to prevent one follow-up treatment was 1.3. Limitations: sample size limited ability to determine risk factors for treatment failure.

Conclusion: Simultaneous diagnosis and treatment of superficial NMSCs is a successful way of improving efficiency and patient satisfaction.

Sexual and gender minority (SGM) populations include individuals whose sexual orientation, gender identity, or reproductive development is characterized by nonbinary sexual constructs (e.g., lesbian, gay, bisexual, and transgender (LGBT) individuals). Previous research suggests that some SGM populations have higher rates of skin cancer. The purpose of this study was to assess the association of diverse SGM identities with indoor tanning, a risk factor for skin cancer, while exploring other relevant co-occurring risk factors. A secondary analysis was performed on the 2020 LGBT Health Needs Assessment collected by the Pennsylvania Department of Health. Measures included sexual orientation, gender identity, healthcare utilization, and cancer risk factors. Cisgender SGM men are more likely to use indoor tanning devices (adjusted odds ratio (aOR) = 1.79; 95% CI: 1.31-2.44) compared to other SGM subpopulations independent of sexual orientation. Indoor tanning was also associated with alcohol (aOR = 1.94; 95% CI: 1.50-2.51) and tobacco use (aOR = 1.64; 95% CI: 1.21-2.21). Findings suggest that targeted screening for skin cancer risk behaviors could accompany standard tobacco and alcohol screenings in clinical practice.

Aims: In chronic osteomyelitis-derived squamous cell carcinoma, what are the demographic and clinical variables, risk factors associated with worse outcomes, and results of treatment modalities used?

Methods: A systematic review was performed using PubMed and EMBASE. Articles were evaluated for inclusion and exclusion criteria, and for quality analysis. PRISMA guidelines were applied. Demographic and clinical data and therapeutic approaches were presented narratively and in descriptive statistics registered at PROSPERO.

Results: Most patients were male (40/49), trauma was the most common etiology (27/36), and about half of all SCC were in the tibia (25/48). Amputation was the main definitive treatment (42/47). Adjuvant treatments were not analyzed. Well-differentiated SCC accounted for 58.3% (21/36) of all tumors. Bone invasion was described in 82.8% (24/29); recurrence, in 7.7% (3/39); and metastasis, in 7.7% (3/39). Recurrence and metastasis occurred more frequently when bone invasion was present (p = 0.578 and p = 0.646, respectively). SCC with lymph node involvement showed a higher tendency to metastasize (p = 0.377). Compared with limb salvage, amputation was associated with a tendency for less recurrence (p = 0.312) and longer survival (p = 0.219).

Conclusions: COM-derived SCC mostly occurs after trauma and is usually located in the tibia. Bone invasion is common, and patients predominantly undergo amputation. This treatment is associated with a trend toward higher survival, compared to limb salvage.