Journal of Skin Cancer The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Gender-Based Differences and Barriers in Skin Protection Behaviors in Melanoma Survivors Thu, 25 Aug 2016 16:24:21 +0000 Purpose. Skin protection behaviors and environmental exposure play a crucial role in the development and subsequent management of melanoma. This study investigates gender-based differences in skin protection behaviors after melanoma treatment. Methods. Patients diagnosed and surgically treated for cutaneous melanomas over the last six years in a geographically high risk area were surveyed over telephone using a standardized script. Results. Of 150 survey results obtained, there were 82 males and 68 females. Overall, 87% of participants reported skin self-examination for abnormal markings more often and 94% reported wearing skin protective clothing more often, with females being more than males. Females limited outdoor activity more often than males, 79% to 54%, . When outside, females sought shade more often than males, 75% to 56%, . However, males wore a wide brim hat more often than females, 52% to 28%, . Interestingly, 60% of participants reported wearing SPF 30 sunscreen less often, . Conclusion. Larger percentage of females adopted behavioral changes to prevent future melanoma. Those living in high risk areas and with outdoor occupations need particular attention to skin care. Population based screening should be adopted to deal with this rising public health crisis. Jeffrey Chen, Johnny Shih, Andrew Tran, Aaron Mullane, Christina Thomas, Nail Aydin, and Subhasis Misra Copyright © 2016 Jeffrey Chen et al. All rights reserved. Current Data on Risk Factor Estimates Does Not Explain the Difference in Rates of Melanoma between Hispanics and Non-Hispanic Whites Tue, 22 Mar 2016 06:31:02 +0000 United States Hispanics have seven times lower melanoma incidence rates than non-Hispanic whites (NHW). It is unclear whether this difference can be explained solely by phenotypic risk factors, like darker skin, or whether modifiable risk factors, like sun exposure, also play a role. The purpose of this paper is to summarize what is currently known about melanoma risk factors among Hispanics and NHWs, and whether or not those differences could explain the difference in melanoma incidence. Through literature review, relative risks and prevalence of melanoma risk factors in Hispanics and NHWs were identified and used to calculate the expected rate in Hispanics and rate ratio compared to NHWs. We found that melanoma risk factors either have similar frequency in Hispanics and NHWs (e.g., many large nevi) or are less frequent in Hispanics but do not explain a high proportion of disease variation (e.g., red hair). Considering current knowledge of risk factor prevalence, we found that melanoma incidence rates in the two groups should actually be similar. Sun exposure behavior among Hispanics may contribute to the explanation for the 7-fold difference in melanoma rates. Currently, limited data exist on sun exposure behavior among Hispanics, but possibilities for improving primary prevention by further studying these practices are substantial. Sonia Kamath, Kimberly A. Miller, and Myles G. Cockburn Copyright © 2016 Sonia Kamath et al. All rights reserved. Kaposi Sarcoma among HIV Infected Patients in Lagos University Teaching Hospital, Nigeria: A 14-Year Retrospective Clinicopathological Study Sun, 13 Mar 2016 11:14:20 +0000 Background. Despite the increased incidence of Kaposi sarcoma (KS) resulting from the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic, there is still significant underreporting of KS in this environment. Objectives. This study was aimed at determining the incidence and clinicopathologic patterns of KS among HIV infected patients in Lagos University Teaching Hospital (LUTH), Nigeria, over a 14-year period: January 2000 to December 2013. Methodology. The materials for this study included patients’ hospital clinical files, duplicate copies of histopathologic reports, and tissue blocks and corresponding archival slides in the Anatomic and Molecular Pathology Department and the HIV/AIDS unit of the Department of Haematology. Results. Within the study period, 182 cases of KS were diagnosed, accounting for 1.2% of all patients managed for HIV/AIDS and 2.99% of solid malignant tumours. The male-to-female ratio and modal age group were 1 : 1.3 and 5th decade, respectively. Most cases (90%) had purely mucocutaneous involvement with the lower limb being the commonest site (65.8%). The majority of lesions were plaques (65.8%). Vascular formation was the predominant histologic type seen (43.5%). Conclusion. KS in Lagos followed the same epidemiologic trend as other centers in Nigeria, with an increasing incidence in this era of HIV/AIDS. Olakanmi Akinde, Omobolade Obadofin, Titilope Adeyemo, Oladipo Omoseebi, Nzechukwu Ikeri, Ikechukwu Okonkwo, and Olatunji Afolayan Copyright © 2016 Olakanmi Akinde et al. All rights reserved. Inflammatory Bowel Disease and Skin Cancer: An Assessment of Patient Risk Factors, Knowledge, and Skin Practices Mon, 29 Feb 2016 11:25:10 +0000 Objective. Patients with inflammatory bowel disease (IBD) are at increased risk from skin cancer. Aims include assessing IBD patients’ risk factors and knowledge of skin cancer and current skin protection practices to identify gaps in patient education regarding skin cancer prevention in IBD. Methods. IBD patients 18 years were recruited to complete an online survey. Results. 164 patients (mean age 43.5 years, 63% female) with IBD (67% Crohn’s disease, 31% ulcerative colitis, and 2% indeterminate colitis) were included. 12% () of patients had a personal history and 34% () had a family history of skin cancer. Females scored better on skin protection (16.94/32 versus 14.53/32, ) and awareness (35.16/40 versus 32.98/40, ). Patients over 40 years old scored better on prevention (17.45/28 versus 15.35/28, ). Patients with skin cancer scored better on prevention (20.56/28 versus 15.75/28, ) and skin protection (21.47/32 versus 15.33/32, ). 61% of patients recognized the link between skin cancer and IBD. Conclusions. The majority of IBD patients are aware of the link between skin cancer and IBD; however, skin protection practices are suboptimal. This emphasizes the role of healthcare professionals in providing further education for skin cancer prevention in the IBD population. Jessica N. Kimmel, Tiffany H. Taft, and Laurie Keefer Copyright © 2016 Jessica N. Kimmel et al. All rights reserved. Is There a Relationship between the Stratum Corneum Thickness and That of the Viable Parts of Tumour Cells in Basal Cell Carcinoma? Thu, 28 Jan 2016 13:05:20 +0000 Basal cell carcinoma (BCC) is an invasive epithelial skin tumour. The thickness of the outermost epidermal layer of the skin, the stratum corneum (SC), influences drug uptake and penetration into tumour and may thereby affect the response of BCC to topical treatment. The aim was to investigate a possible relationship between the thickness of the SC and that of the viable part of BCC. Histopathological evaluations of the corresponding SC and viable tumour thickness measurements of individual BCCs of different subtypes were explored. A total of 53 BCCs from 46 patients were studied. The median tumour thickness was 1.7 mm (0.8–3.0 mm), with a significant difference between subtypes (). The SC had a median thickness of 0.3 mm (0.2–0.4 mm), with no difference between tumour subtypes (). Additionally, no significant association between the thickness of the SC and that of the viable part of the tumour was demonstrated (). In conclusion our results indicate that SC thickness is relatively constant in BCC. Olav A. Foss, Patricia Mjønes, Silje Fismen, and Eidi Christensen Copyright © 2016 Olav A. Foss et al. All rights reserved. Reporting Melanoma: A Nationwide Surveillance of State Cancer Registries Tue, 29 Dec 2015 13:08:59 +0000 The goal of our study was to determine current melanoma reporting methods available to dermatologists and dermatopathologists and quantify changes in reporting methods from 2012 to 2014. A cross-sectional study design was utilized consisting of website perusal of reporting procedures, followed up by telephone and email inquiry of reporting methods from every state cancer registry. This study was conducted over a six-month period from February to August 2014. A previous similar survey was conducted in 2012 over the same time frame and results were compared. Kansas state cancer registry provided no data. As of August 2014, 96% of 49 state cancer registries had electronic methods available to all designated reporters. Seven (14%) states required an electronic-only method of reporting melanoma cases. Eighty-six percent allowed hard copy pathology report submission. Compared to the 2012 survey, 2 additional states were found to have initiated electronic reporting methods by 2014. In conclusion, a variety of methods exist for reporting diagnosed melanoma cases. Although most state cancer registries were equipped for electronic transmission of cases for mandated reporters, a number of states were ill-equipped for electronic submission from outpatient dermatologists. There was a general trend towards electronic versus nonelectronic reporting from 2012 to 2014. Kehinde O. Raji, Lauren Payne, and Suephy C. Chen Copyright © 2015 Kehinde O. Raji et al. All rights reserved. Diet and Skin Cancer: The Potential Role of Dietary Antioxidants in Nonmelanoma Skin Cancer Prevention Sun, 25 Oct 2015 11:36:35 +0000 Nonmelanoma skin cancer (NMSC) is the most common cancer among Americans. Ultraviolet (UV) radiation exposure is the major risk factor for the development of NMSC. Dietary AOs may prevent free radical-mediated DNA damage and tumorigenesis secondary to UV radiation. Numerous laboratory studies have found that certain dietary AOs show significant promise in skin cancer prevention. These results have been substantiated by animal studies. In human studies, researchers have evaluated both oral AO supplements and dietary intake of AOs via whole foods. In this review, we provide an overview of the role of AOs in preventing tumorigenesis and outline four targeted dietary AOs. We review the results of research evaluating oral AOs supplements as compared to dietary AOs intake via whole foods. While these specific supplements have not shown efficacy, intake of AOs via consumption of whole foods has shown some promise. Lessons learned from the field of hypertension research may provide important guidance in future study design. Further research on the role of dietary AOs in the prevention of NMSC is warranted and should focus on intake via whole food consumption. Rajani Katta and Danielle Nicole Brown Copyright © 2015 Rajani Katta and Danielle Nicole Brown. All rights reserved. Reducing Sun Exposure for Prevention of Skin Cancers: Factorial Invariance and Reliability of the Self-Efficacy Scale for Sun Protection Thu, 17 Sep 2015 10:53:27 +0000 The Self-Efficacy Scale for Sun Protection consists of two correlated factors with three items each for Sunscreen Use and Avoidance. This study evaluated two crucial psychometric assumptions, factorial invariance and scale reliability, with a sample of adults participating in a computer-tailored, population-based intervention study. A measure has factorial invariance when the model is the same across subgroups. Three levels of invariance were tested, from least to most restrictive: (1) Configural Invariance (nonzero factor loadings unconstrained); (2) Pattern Identity Invariance (equal factor loadings); and (3) Strong Factorial Invariance (equal factor loadings and measurement errors). Strong Factorial Invariance was a good fit for the model across seven grouping variables: age, education, ethnicity, gender, race, skin tone, and Stage of Change for Sun Protection. Internal consistency coefficient Alpha and factor rho scale reliability, respectively, were .84 and .86 for Sunscreen Use, .68 and .70 for Avoidance, and .78 and .78 for the global (total) scale. The psychometric evidence demonstrates strong empirical support that the scale is consistent, has internal validity, and can be used to assess population-based adult samples. Steven F. Babbin, Hui-Qing Yin, Joseph S. Rossi, Colleen A. Redding, Andrea L. Paiva, and Wayne F. Velicer Copyright © 2015 Steven F. Babbin et al. All rights reserved. Oculocutaneous Albinism and Squamous Cell Carcinoma of the Skin of the Head and Neck in Sub-Saharan Africa Wed, 12 Aug 2015 11:30:08 +0000 Oculocutaneous albinism which is characterised by impaired melanin biosynthesis is the most common inherited pigmentary disorder of the skin and it is common among Blacks in sub-Saharan Africa. All albinos are at great risk of developing squamous cell carcinoma of sun-exposed skin, and Black albinos in sub-Saharan Africa are at about a 1000-fold higher risk of developing squamous cell carcinoma of the skin than the general population. In Black albinos, skin carcinoma tends to run an aggressive course and is likely to recur after treatment, very probably because the aetiology and predisposing factors have not changed. Prevention or reduction of occurrence of squamous cell carcinoma of the skin in Black albinos might be achieved through educating the population to increase awareness of the harmful effects of exposure to sunlight and at the same time making available effective screening programs for early detection of premalignant and malignant skin lesions in schools and communities and for early treatment. P. T. Lekalakala, R. A. G. Khammissa, B. Kramer, O. A. Ayo-Yusuf, J. Lemmer, and L. Feller Copyright © 2015 P. T. Lekalakala et al. All rights reserved. Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis Wed, 10 Jun 2015 06:17:44 +0000 Purpose. Two BRAFV600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000–$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed. Vanessa Shih, Renske M. ten Ham, Christine T. Bui, Dan N. Tran, Jie Ting, and Leslie Wilson Copyright © 2015 Vanessa Shih et al. All rights reserved. Comorbidity Assessment in Skin Cancer Patients: A Pilot Study Comparing Medical Interview with a Patient-Reported Questionnaire Tue, 09 Jun 2015 11:17:05 +0000 Background. Comorbidities are conditions that occur simultaneously but independently of another disorder. Among skin cancer patients, comorbidities are common and may influence management. Objective. We compared comorbidity assessment by traditional medical interview (MI) and by standardized patient-reported questionnaire based on the Adult Comorbidity Evaluation-27 (ACE-27). Methods. Between September 2011 and October 2013, skin cancer patients underwent prospective comorbidity assessment by a Mohs surgeon (MI) and a radiation oncologist (using a standardized patient-reported questionnaire based on the ACE-27, the PRACE-27). Comorbidities were identified and graded according to the ACE-27 and compared for agreement. Results. Forty-four patients were evaluated. MI and PRACE-27 identified comorbidities in 79.5% and 88.6% () of patients, respectively. Among 27 comorbid ailments, the MI identified 9.9% as being present, while the PRACE-27 identified 12.5%. When there were discordant observations, PRACE-27 was more likely than MI to identify the comorbidity (, 95% CI = 2.4–14.4, ). Overall comorbidity scores were moderate or severe in 43.2% (MI) versus 59.1% (PRACE-27) (). Limitations. Small sample size from a single institution. Conclusion. Comorbidities are common in skin cancer patients, and a standardized questionnaire may better identify and grade them. More accurate comorbidity assessments may help guide skin cancer management. Erica H. Lee, Rajiv I. Nijhawan, Kishwer S. Nehal, Stephen W. Dusza, Amanda Levine, Amanda Hill, and Christopher A. Barker Copyright © 2015 Erica H. Lee et al. All rights reserved. Mycosis Fungoides in Iranian Population: An Epidemiological and Clinicopathological Study Wed, 28 Jan 2015 13:45:30 +0000 Background. Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. Extensive studies on Iranian MF patients are absent. The present study aimed to produce updated clinical information on Iranian MF patients. Methods. This was a retrospective, descriptive, single-center study, including all cases of MF seen in the Department of Dermatology, University Hospital of Isfahan, Iran, between 2003 and 2013. Data systematically recorded for each patient included clinical, biological, histological, and molecular findings. Results. Eighty-six patients with clinical and histologic diagnosis of MF were included in the study. Thirty-nine patients (45.3%) were male. Female predominance was observed in patients (male : female ratio is 1 : 1.2). Patients were between 7 and 84 years of age (median: 41). The interval from disease onset to diagnosis ranged from 0 to 55 years (median: 1 year). Eighteen cases (20.9%) had unusual variants of MF. The most common types included hypopigmented and poikilodermatous MF. Childhood cases of MF constituted 5.8% (5/86) of all patients. The early stages were seen in 82 cases (95.34%). Conclusion. The major differences in epidemiologic characteristics of MF in Iran are the lack of male predominance and the lower age of patients at the time of diagnosis. Farahnaz Fatemi Naeini, Bahareh Abtahi-Naeini, Hamidreza Sadeghiyan, Mohammad Ali Nilforoushzadeh, Jamshid Najafian, and Mohsen Pourazizi Copyright © 2015 Farahnaz Fatemi Naeini et al. All rights reserved. Dual S-100-AE1/3 Immunohistochemistry to Detect Perineural Invasion in Nonmelanoma Skin Cancers Sun, 18 Jan 2015 08:12:49 +0000 Background. Perineural invasion (PNI) is an adverse prognostic histologic finding and increases the risk of local recurrence and metastasis. Objective. We aimed to determine if dual immunohistochemical (IHC) staining with S-100 and AE1/3 would increase the detection of PNI on nonmelanoma skin cancers (NMSCs). Methods. We collected 45 specimens of NMSCs in which there was clinical suspicion for PNI. Two dermatopathologists independently reviewed the tumors for the unequivocal presence of PNI. Results. Unequivocal PNI was present on 10 of the 45 tumors by H&E staining and on 15 of the 45 tumors by IHC staining. Large nerves (>0.1 mm) were involved in 3 of 10 H&E-stained cases and 3 of 15 IHC-stained cases, with 2 of the 4 cases demonstrating large nerve involvement with both staining methods. Of the 8 cases of PNI detected only on IHC, 7 were small nerves (≤0.1 mm). Limitations. All cases were selected because they were clinically suspicious for PNI, and this may be considered selection bias. Conclusions. PNI detection may be increased using dual S-100 and AE1/3 staining, but the majority of additional cases detected were small nerves. The clinical significance, given the small size of the involved nerves, is unclear. Alma C. Berlingeri-Ramos, Claire J. Detweiler, Richard F. Wagner Jr., and Brent C. Kelly Copyright © 2015 Alma C. Berlingeri-Ramos et al. All rights reserved. Risk of Second Cancers in Merkel Cell Carcinoma: A Meta-Analysis of Population Based Cohort Studies Wed, 10 Dec 2014 09:55:21 +0000 The risk of second cancers in Merkel cell carcinoma (MCC) remains uncertain since risk estimates vary worldwide. The global MCC population is growing and there is a demand for better knowledge of prognosis of this disease. The Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE search engines were searched for the relevant literature between January 1999 and September 2014 by use of explicit search criteria. The main outcome was second malignancies associated with MCC patients measured by standardized incidence ratios (SIRs) or other estimates of risks. Five papers fulfilled the inclusion criteria and reported SIRs of second cancer in MCC which varied from 1.07 to 2.80. Performing meta-analysis using random effects model revealed that there was an increased risk for second malignancies due to MCC (SIR, 1.52; 95% CI, 1.10–2.11). There was a significant increase in risk for malignant melanoma (SIR, 3.09; 95% CI, 2.02–4.73) as compared to all common second malignancies among the studies. Updated knowledge about risk of second malignancies in MCC will help in better assessment of the disease prognosis and will help in optimizing the medical and surgical treatment, radiotherapy, follow-up, and surveillance procedures. Anshul Saxena, Muni Rubens, Venkataraghavan Ramamoorthy, and Hafiz Khan Copyright © 2014 Anshul Saxena et al. All rights reserved. Validity and Stability of the Decisional Balance for Sun Protection Inventory Sun, 07 Dec 2014 07:29:12 +0000 The 8-item Decisional Balance for sun protection inventory (SunDB) assesses the relative importance of the perceived advantages (Pros) and disadvantages (Cons) of sun protective behaviors. This study examined the psychometric properties of the SunDB measure, including invariance of the measurement model, in a population-based sample of adults. Confirmatory factor analyses supported the theoretically based 2-factor (Pros, Cons) model, with high internal consistencies for each subscale (). Multiple-sample CFA established that this factor pattern was invariant across multiple population subgroups, including gender, racial identity, age, education level, and stage of change subgroups. Multivariate analysis by stage of change replicated expected patterns for SunDB (Pros , Cons ). These results demonstrate the internal and external validity and measurement stability of the SunDB instrument in adults, supporting its use in research and intervention. Hui-Qing Yin, Joseph S. Rossi, Colleen A. Redding, Andrea L. Paiva, Steven F. Babbin, and Wayne F. Velicer Copyright © 2014 Hui-Qing Yin et al. All rights reserved. The Experience of Melanoma Follow-Up Care: An Online Survey of Patients in Australia Wed, 19 Nov 2014 00:00:00 +0000 Investigating patients’ reports on the quality and consistency of melanoma follow-up care in Australia would assist in evaluating if this care is effective and meeting patients’ needs. The objective of this study was to obtain and explore the patients’ account of the technical and interpersonal aspects of melanoma follow-up care received. An online survey was conducted to acquire details of patients’ experience. Participants were patients treated in Australia for primary melanoma. Qualitative and quantitative data about patient perceptions of the nature and quality of their follow-up care were collected, including provision of melanoma specific information, psychosocial support, and imaging tests received. Inconsistencies were reported in the provision and quality of care received. Patient satisfaction was generally low and provision of reassurance from health professionals was construed as an essential element of quality of care. “Gaps” in follow-up care for melanoma patients were identified, particularly provision of adequate psychosocial support and patient education. Focus on strategies for greater consistency in the provision of support, information, and investigations received, may generate a cost dividend which could be reinvested in preventive and supportive care and benefit patient well-being. Janine Mitchell, Peta Callaghan, Jackie Street, Susan Neuhaus, and Taryn Bessen Copyright © 2014 Janine Mitchell et al. All rights reserved. Sun Protection Beliefs among Hispanics in the US Sun, 09 Nov 2014 14:04:57 +0000 Purpose. We reviewed the literature on sun protection beliefs in Hispanics living in the United States to explore what challenges are faced by area of research. Method. A review of PubMED, PsycINFO, and CINAHL databases was performed. Studies were published in peer-reviewed journals (in all years available) and written in English. The search terms used were [“skin cancer” OR “sun protection”] AND [“Latino” OR “Hispanic”] AND “beliefs.” Eligible papers were included in the final analysis after meeting the following inclusion criteria: (1) the records had to quantitatively examine and report sun protection beliefs in Hispanics, (2) the number of Hispanic participants in the sample had to be clearly specified, and (3) studies reporting differences in sun protection beliefs between Hispanics and other racial and ethnic groups were included in the review. Results. Of the 92 articles identified, 11 met inclusion criteria and addressed sun protection beliefs regarding skin cancer seriousness and susceptibility, and benefits and barriers of sun protection and skin cancer risk behaviors. Characteristics of studies and results were examined. Conclusion. There is insufficient evidence to determine a pattern of sun protection beliefs among Hispanics in the United States. More quality studies are needed which focus on sun protection beliefs in Hispanics. Marimer Santiago-Rivas, Chang Wang, and Lina Jandorf Copyright © 2014 Marimer Santiago-Rivas et al. All rights reserved. A Study of Basal Cell Carcinoma in South Asians for Risk Factor and Clinicopathological Characterization: A Hospital Based Study Mon, 03 Nov 2014 07:55:57 +0000 Objectives. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute number of cases may be significant due to large population. The existing literature on BCC in India is scant. So, this study was done focusing on its epidemiology, risk factors, and clinicopathological aspects. Methods. A hospital based cross-sectional study was conducted in Punjab, North India, from 2011 to 2013. History, examination and histopathological confirmation were done in all the patients visiting skin department with suspected lesions. Results. Out of 36 confirmed cases, 63.9% were females with mean ± SD age being years. Mean duration of disease was 4.7 years. Though there was statistically significant higher sun exposure in males compared to females ( value being 0.000), BCC was commoner in females, explainable by intermittent sun exposure (during household work in the open kitchens) in women. Majority of patients (88.9%) had a single lesion. Head and neck region was involved in 97.2% of cases, with nose being the commonest site (50%) with nodular/noduloulcerative morphology in 77.8% of cases. Pigmentation was evident in 22.2% of cases clinically. Nodular variety was the commonest histopathological variant (77.8%). Conclusions. This study highlights a paradoxically increasing trend of BCC with female preponderance, preferential involvement of nose, and higher percentage of pigmentation in Indians. Sumir Kumar, Bharat Bhushan Mahajan, Sandeep Kaur, Ashish Yadav, Navtej Singh, and Amarbir Singh Copyright © 2014 Sumir Kumar et al. All rights reserved. Evaluation of the Definitions of “High-Risk” Cutaneous Squamous Cell Carcinoma Using the American Joint Committee on Cancer Staging Criteria and National Comprehensive Cancer Network Guidelines Wed, 17 Sep 2014 00:00:00 +0000 Recent guidelines from the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) have been proposed for the assessment of “high-risk” cutaneous squamous cell carcinomas (cSCCs). Though different in perspective, both guidelines share the common goals of trying to identify “high-risk” cSCCs and improving patient outcomes. Thus, in theory, both definitions should identify a similar proportion of “high-risk” tumors. We sought to evaluate the AJCC and NCCN definitions of “high-risk” cSCCs and to assess their concordance. Methods. A retrospective review of head and neck cSCCs seen by an academic dermatology department from July 2010 to November 2011 was performed. Results. By AJCC criteria, most tumors (%) were of Stage 1; 46 tumors (13.9%) were of Stage 2. Almost all were of Stage 2 due to size alone (≥2 cm); one tumor was “upstaged” due to “high-risk features.” Using the NCCN taxonomy, 231 (87%) of tumors were “high-risk.” Discussion. This analysis demonstrates discordance between AJCC and NCCN definitions of “high-risk” cSCC. Few cSCCs are of Stage 2 by AJCC criteria, while most are “high-risk” by the NCCN guidelines. While the current guidelines represent significant progress, further studies are needed to generate a unified definition of “high-risk” cSCC to optimize management. Melinda B. Chu, Jordan B. Slutsky, Maulik M. Dhandha, Brandon T. Beal, Eric S. Armbrecht, Ronald J. Walker, Mark A. Varvares, and Scott W. Fosko Copyright © 2014 Melinda B. Chu et al. All rights reserved. Six Years of Experience in Photodynamic Therapy for Basal Cell Carcinoma: Results and Fluorescence Diagnosis from 191 Lesions Sun, 14 Sep 2014 06:21:36 +0000 Background. Photodynamic therapy (PDT) has become a therapeutic option for basal cell carcinoma (BCC) in the last decade. Objectives. To study the results and predictors of BCC response to treatment with PDT and to evaluate fluorescence diagnosis of BCC. Methods. A descriptive, retrospective, and observational study was carried out. Patients with biopsy-confirmed BCC who were treated with methyl aminolevulinate and red light according to standard treatment protocols (2 sessions separated by 2 weeks, 630 nm, 37 J/cm2, 8 minutes, Aktilite) were selected. Response was scored as clinically complete and incomplete and the patients were followed up every three months. Results. Data from 191 BCC in 181 patients with a mean age of 69.55 years and a mean follow-up period of 34.4 months were collected. The overall response was 74% of the BCC treated, with the best response in superficial BCC with a 95% of complete response. The regression analysis revealed that the superficial histological type was the primary factor predictive of a complete response. Conclusions. In the treatment of BCC with PDT, the most significant factor for predicting response is the histological type. M. Fernández-Guarino, A. Harto, B. Pérez-García, A. Royuela, and P. Jaén Copyright © 2014 M. Fernández-Guarino et al. All rights reserved. A Clinicopathological and Immunohistochemical Correlation in Cutaneous Metastases from Internal Malignancies: A Five-Year Study Mon, 25 Aug 2014 10:43:40 +0000 Cutaneous metastases from internal malignancies are uncommon and occur in 0.6%–10.4% of all patients with cancer. In most cases, cutaneous metastases develop after the initial diagnosis of the primary internal malignancy and late in the course of the disease. Skin tumors are infrequent in Asian population and cutaneous metastases are quite rare. Cutaneous metastases carry a poor prognosis with average survival of few months. In the present five-year study 1924 malignant tumors were screened which included only nine cases of cutaneous metastatic deposits. A wide range of site and clinical presentations including nodules, plaques, and ulcers was noted. Histopathological findings were significant and corresponded with the primary internal malignancy. Cutaneous metastases from breast carcinoma (44.4%) were the most common finding followed by non-Hodgkin lymphoma and renal cell carcinoma (22.2% each) and carcinoma cervix (11.1%). The aim of our study is to classify the cutaneous metastases and to evaluate their clinicopathologic and immunohistochemical correlation with the primary tumor. Sarita Nibhoria, Kanwardeep Kaur Tiwana, Manmeet Kaur, and Sumir Kumar Copyright © 2014 Sarita Nibhoria et al. All rights reserved. Decrease in Self-Reported Tanning Frequency among Utah Teens following the Passage of Utah Senate Bill 41: An Analysis of the Effects of Youth-Access Restriction Laws on Tanning Behaviors Wed, 20 Aug 2014 11:24:19 +0000 Introduction. Adolescent use of indoor tanning facilities is associated with an increased risk in later development of melanoma skin cancers. States that have imposed age restrictions on access to indoor tanning generally show lower self-reported rates of indoor tanning than states with no restrictions, but currently no studies have assessed indoor tanning use before and after such restrictions. Methods. In 2013, we compared self-reported indoor tanning data collected in the Prevention Needs Assessment (PNA) survey in 2011 to PNA 2013 data. We also assessed predictors of continued tanning after passage of the bill. Results. Prior to the passage of Senate Bill 41, 12% of students reported at least one incident of indoor tanning in the past 12 months. After passage, only 7% of students reported indoor tanning in the past 12 months (P < 0.0001). Students who continued indoor tanning were more likely to be older and female and to engage in other risk behaviors, including smoking and alcohol use. Lower parental education levels were also associated with continued tanning. Conclusion. Indoor tanning restrictions showed beneficial impact on tanning rates in adolescents in Utah. Stricter restrictions may show even greater impact than restrictions that allow for parental waivers. Stronger enforcement of bans is needed to further reduce youth access. Rebecca G. Simmons, Kristi Smith, Meghan Balough, and Michael Friedrichs Copyright © 2014 Rebecca G. Simmons et al. All rights reserved. Melanocyte and Melanoma Cell Activation by Calprotectin Tue, 12 Aug 2014 11:52:40 +0000 Calprotectin, a heterodimer of S100A8 and S100A9, is a proinflammatory cytokine released from ultraviolet radiation-exposed keratinocytes. Calprotectin binds to Toll-like receptor 4, the receptor for advanced glycation end-products, and extracellular matrix metalloproteinase inducer on target cells to stimulate migration. Melanocytes and melanoma cells produce little if any calprotectin, but they do express receptors for the cytokine. Thus, keratinocyte-derived calprotectin has the potential to activate melanocytes and melanoma cells within the epidermis in a paracrine manner. We examined the ability of calprotectin to stimulate proliferation and migration in normal human melanocytes and melanoma cells in vitro. We first showed, by immunofluorescence and quantitative RT-PCR, that the melanocytic cells employed expressed a calprotectin receptor, the receptor for advanced end-products. We then demonstrated that calprotectin significantly enhanced proliferation, migration, and Matrigel invasion in both normal human melanocytes and melanoma cells. Thus, calprotectin is one of the numerous paracrine factors released by ultraviolet radiation-exposed keratinocytes that may promote melanomagenesis and is a potential target for melanoma prevention or therapy. Stephanie H. Shirley, Kristine von Maltzan, Paige O. Robbins, and Donna F. Kusewitt Copyright © 2014 Stephanie H. Shirley et al. All rights reserved. Locally Advanced and Unresectable Cutaneous Squamous Cell Carcinoma: Outcomes of Concurrent Cetuximab and Radiotherapy Mon, 21 Jul 2014 00:00:00 +0000 Background. Advanced age and immune dysfunction are risk factors for cutaneous squamous cell carcinoma (cSCC) and often render patients with locally-advanced disease medically inoperable or surgically unresectable, but potentially curable with radiotherapy. Concurrent chemotherapy and radiotherapy may not be well tolerated in this population, but another systemic therapy may improve disease control. Objective. Determine the tolerance and efficacy of concurrent cetuximab and radiotherapy (CRT) for patients with locally advanced and unresectable cSCC. Methods. Retrospective analysis of 12 patients treated with CRT for locally advanced and unresectable cSCC. Results. Patients were elderly and 75% had moderate-to-severe comorbidities, while 42% had immune dysfunction. Grades 3-4 adverse events were noted in 83% of patients; 67% required hospital admission for adverse events. Complete and partial response was noted in 36% and 27% (response rate, 64%). Stable and progressive disease was noted in 3 and 1 patients, respectively (disease control rate, 91%). Median progression-free and overall survival were 6.4 and 8.0 months, respectively. Limitations. Retrospective small-cohort, single-institution analysis. Conclusion. Patients selected for CRT were elderly, with comorbidities and immune dysfunction, but treatment responses were observed. Patients selected for this treatment approach have a poor prognosis with limited capacity for therapy; more effective treatment is needed. Robert M. Samstein, Alan L. Ho, Nancy Y. Lee, and Christopher A. Barker Copyright © 2014 Robert M. Samstein et al. All rights reserved. The Influence of the Coexpression of CD4 and CD8 in Cutaneous Lesions on Prognosis of Mycosis Fungoides: A Preliminary Study Sun, 20 Jul 2014 07:03:54 +0000 Background. Although techniques of immunophenotyping have been successful in characterizing the cells in the cutaneous infiltrates of mycosis fungoides little evidence suggests that variations in the phenotypic characterization correlate with prognosis. Objectives. In a preliminary prospective, single-centre, study we correlated the T-cell phenotype in cutaneous biopsies with the progression of the disease to determine whether the coexpression of CD4 and CD8 has an impact on prognosis. Methods. Skin biopsy specimens from 30 newly diagnosed patients were stained with immunoperoxidase techniques to determine their phenotypic characteristics. After a median followup of 42 months patients were divided into two groups with stable and progressive disease. Results. Eighteen patients had the conventional CD4+CD8− T-cell phenotype. Ten patients showed the coexpression of CD4 and CD8 and had a slightly lower rate of progressive disease. Conclusions. The coexpression of CD4 and CD8 in cutaneous lesions is not rare and is associated with a slightly lower rate of progressive disease. Since double positive CD4/CD8 phenotype is rarely reported in mycosis fungoides the presence on conventional immunophenotyping of both CD may be due to a “mixture” of neoplastic cells and inflammatory CD8+ tumor infiltrating lymphocytes. Immunohistochemical study combined with confocal microscopy could clarify this issue. Sergio Umberto De Marchi, Giuseppe Stinco, Enzo Errichetti, Serena Bonin, Nicola di Meo, and Giusto Trevisan Copyright © 2014 Sergio Umberto De Marchi et al. All rights reserved. Saphenous Vein Sparing Superficial Inguinal Dissection in Lower Extremity Melanoma Sun, 13 Jul 2014 12:06:26 +0000 Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient’s quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity. Muhammed Beşir Öztürk, Arzu Akan, Özay Özkaya, Onur Egemen, Ali Rıza Öreroğlu, Turgut Kayadibi, and Mithat Akan Copyright © 2014 Muhammed Beşir Öztürk et al. All rights reserved. Prognostic Value of Melanoma Inhibitory Activity Protein in Localized Cutaneous Malignant Melanoma Sun, 22 Jun 2014 12:31:15 +0000 Background. Cutaneous malignant melanoma (CMM) is a heterogeneous disease, acknowledged for its lack of predictability regarding clinical evolution. In order to appreciate a patient’s individual prognosis, an attempt is made to find new tumor markers that parallel the disease progression. Objective. To identify if melanoma inhibitory activity (MIA) protein could represent a tool for selecting high risk early stages melanoma patients. Method. Between 2008 and 2013, 155 patients with CMM were treated in our clinic. 84 of them were classified into stages I and II, according to TNM 2009. MIA serum concentration was measured in all patients and 50 healthy donors. A cut-off value of 9.4 ng/ml was established using the ROC curve. Results. All patients were followed up by periodic investigations every 6 months. We have noticed that 66% of patients with MIA serum values at diagnosis greater than 9.4 ng/mL have relapsed, while only 5% of patients with MIA serum concentration below the estimated threshold, recurred during the follow-up period . The death risk was 12 times higher in pathological MIA group of patients . Conclusions. Our data suggest that MIA is an independent prognostic factor for patients with localized CMM. Angela Sandru, Eugenia Panaitescu, Silviu Voinea, Madalina Bolovan, Adina Stanciu, Sabin Cinca, and Alexandru Blidaru Copyright © 2014 Angela Sandru et al. All rights reserved. Assessing the Current Market of Sunscreen: A Cross-Sectional Study of Sunscreen Availability in Three Metropolitan Counties in the United States Thu, 15 May 2014 11:04:52 +0000 Sunscreen use is recommended for the prevention of sunburn and skin cancer. Little is known regarding sunscreen availability in high versus low income communities. We analyzed sunscreen availability in three large metropolitan counties to determine the relationship between availability and community demographics. We included sun care products in all pharmacies and supermarkets open as of July 2013 in representative high and low income zip codes in Cook County, Illinois, Miami-Dade County, Florida, and San Diego County, California. We recorded the percentage of tanning oil, sunscreens with a sun protection factor (SPF) < 15, SPF > 15, physical sunscreens, spray sunscreens, mean price per ounce (PPO), and mean SPF. Of the total products assessed, 11.0% were tanning oils, with physical sunscreens accounting for only 3.4% of the available sunscreens and 46.2% of sunscreens being spray-on. A comparison between higher and lower income zip codes demonstrated a significantly increased percentage of sunscreens with SPF < 15 in high income zip codes. Lower income zip codes had higher percentages of sunscreens with SPF > 15 and higher PPO, even when taking into account SPF. Further studies of sunscreen usage patterns in different populations must take into account sunscreen availability and price, as these significantly differ based on the community demographic. Kyle T. Amber, Romi Bloom, Patrick Staropoli, Sonam Dhiman, and Shasa Hu Copyright © 2014 Kyle T. Amber et al. All rights reserved. Squamous Cell Carcinomas of the Skin Explore Angiogenesis-Independent Mechanisms of Tumour Vascularization Tue, 06 May 2014 16:06:38 +0000 Aims. To evaluate the vascularization in basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of the skin. Methods. We performed CD31 (i.e., panendothelial marker) and CD105 (i.e., proliferating endothelium marker) immunostaining on samples of 70 SCCs and 70 BCCs of the skin. We evaluated the relative blood vessel area using the Chalkley counting method in each histologic subtype of these tumours. We calculated the degree of proliferation of blood vessel endothelium dividing CD105-Chalkley score by CD31-Chalkley score. Results. We found significantly higher peritumoral and intratumoral blood vessel area in SCC when compared to BCC (both with CD31 and CD105). Chalkley counts differed significantly between groups with different BCC histologic subtypes and SCC with different grade of differentiation. Surprisingly, the degree of proliferation of blood vessel endothelium was higher in BCC when compared to SCC. Conclusions. While SCC exhibited significantly higher intratumoral and peritumoral blood vessel areas compared to BCC, the relatively low rate of proliferating endothelium in this tumour type suggests the existence of endothelial-sprouting-independent mechanisms of vascularization in SCC. Ievgenia Pastushenko, Tamara Gracia-Cazaña, Sandra Vicente-Arregui, Gert G. Van den Eynden, Mariano Ara, Peter B. Vermeulen, Franciso José Carapeto, and Steven J. Van Laere Copyright © 2014 Ievgenia Pastushenko et al. All rights reserved. Melanoma Development and Progression Are Associated with Rad6 Upregulation and β-Catenin Relocation to the Cell Membrane Tue, 06 May 2014 12:20:29 +0000 We have previously demonstrated that Rad6 and β-catenin enhance each other's expression through a positive feedback loop to promote breast cancer development/progression. While β-catenin has been implicated in melanoma pathogenesis, Rad6 function has not been investigated. Here, we examined the relationship between Rad6 and β-catenin in melanoma development and progression. Eighty-eight cutaneous tumors, 30 nevi, 29 primary melanoma, and 29 metastatic melanomas, were immunostained with anti-β-catenin and anti-Rad6 antibodies. Strong expression of Rad6 was observed in only 27% of nevi as compared to 100% of primary and 96% of metastatic melanomas. β-Catenin was strongly expressed in 97% of primary and 93% of metastatic melanomas, and unlike Rad6, in 93% of nevi. None of the tumors expressed nuclear β-catenin. β-Catenin was exclusively localized on the cell membrane of 55% of primary, 62% of metastatic melanomas, and only 10% of nevi. Cytoplasmic β-catenin was detected in 90% of nevi, 17% of primary, and 8% of metastatic melanoma, whereas 28% of primary and 30% of metastatic melanomas exhibited β-catenin at both locations. These data suggest that melanoma development and progression are associated with Rad6 upregulation and membranous redistribution of β-catenin and that β-catenin and Rad6 play independent roles in melanoma development. Karli Rosner, Darius R. Mehregan, Evangelia Kirou, Judith Abrams, Seongho Kim, Michelle Campbell, Jillian Frieder, Kelsey Lawrence, Brittany Haynes, and Malathy P. V. Shekhar Copyright © 2014 Karli Rosner et al. All rights reserved.