Special Issue:
Challenges and Opportunities in Melanoma
Norman A. Brooks, M.D.
Institution: Skin Cancer Medical Center
Abstract
The majority of physicians treating melanoma in situ recommend a 5mm to 1cm margin with excision into the subcutaneous tissue extending between the superficial and the deep fat. There is always the potential for an unrecognized invasive component in a melanoma in situ, making aqueous zinc chloride solution an ideal agent to treat the excision wound of a melanoma in situ of the trunk and extremities. Zinc chloride solution penetrates deeply and widely, killing and fixing tissue when applied to the excision wound, facilitating the excision by allowing for a simple saucerized excision with a narrower and thinner margin while ensuring the treatment of any possible unrecognized invasive components. Zinc chloride has been used in a paste since 1835 to treat skin cancers and melanoma but unlike pastes zinc chloride in solution is recognized by the U.S. Food & Drug Administration as a generally safe substance (Code of Federal Regulations Title 21 [Part 182]). The solution penetrates as deeply and widely and effectively as in the paste which Mohs described to be an inactive vehicle for the active ingredient, zinc chloride solution. Mohs reported a large significant survival benefit (p=0.003) for invasive melanoma using surgery combined with zinc chloride over conventional melanoma surgery. Zinc chloride solution without the paste is a new medicine effective as a surgical adjuvant in the treatment of the excision wound of a melanoma in situ of the trunk and extremities. Zinc chloride can be used as a surgical adjuvant for any melanoma, but melanoma in situ of the trunk and extremities is the logical starting point for a physician interested in using this adjuvant in the treatment of melanoma. Zinc chloride is very powerful and potentially scarring and should be used on the excision wound of a previously histologically diagnosed melanoma only.
Roberto Anaya-Prado
School of Medicine and Health Sciences, Tecnológico de Monterrey; Division of Research at Centro Médico Puerta de Hierro. In Guadalajara, Jalisco. México
Heli Hernández-González
Department of Surgical Oncology at Regional Hospital 110, Mexican Institute of Social Security
Andres Insunza-Martin del Campo
School of Medicine and Health Sciences, Tecnológico de Monterrey
Michelle M. Anaya-Fernández
Division of Research at Centro Médico Puerta de Hierro. In Guadalajara, Jalisco. México
Consuelo C. Azcona-Ramírez
Division of Research at Centro Médico Puerta de Hierro. In Guadalajara, Jalisco. México
Roberto Anaya-Fernández
School of Medicine at Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Division of Research at Centro Médico Puerta de Hierro. In Guadalajara, Jalisco. México
Bryan Urueta-Chávez
School of Medicine and Health Sciences, Tecnológico de Monterrey
Liam N Méndez-Bisgaard
School of Medicine and Health Sciences, Tecnológico de Monterrey
Juan A. Delgado-Vázquez
Department of Surgical Oncology at Regional Hospital 110, Mexican Institute of Social Security
Adriana D. García-Romero
School of Medicine and Health Sciences, Tecnológico de Monterrey
Abstract
Malignant melanoma (MM) is among the most common cancers in the world. Although incidence has been increasing worldwide, most of the cases have been reported to occur in the European continent. Risk factors for the development of MM have been clearly recognized; yet, the accepted theory is that the risk of melanoma is highly determined by the interplay between genetic factors and exposure to sunlight. Morphological characteristics classify melanoma into four subtypes: Superficial spreading melanoma (SSM); nodular melanoma (NM), Lentigo maligna (LM) and Acral lentiginous melanoma (ALM). SSM represents approximately 70% of the cases. Mitogen-activated protein kinase (MAPK) has been identified as a key regulatory element in most melanomas. MAPK is the most relevant signal pathway in the development of melanoma; while the microphthalmia-associated transcription factor (MITF) is a target of extracellular signal-related kinase (ERK) and controls the production of the pigment melanin, cell cycling and survival. Surgical resection is still considered the cornerstone of the treatment in the vast majority of patients with early-stage melanoma. However, treatment of metastatic or recurrent melanoma has significantly been improved with the advent of targeted immunotherapies. The greatest advantage has been observed with the use of checkpoint-inhibitor immunotherapy. But, Adoptive cell therapy (ACT) for the treatment of metastatic melanoma, in patients who have progressed to immunotherapy and/or targeted therapies without success, is currently under investigation with promising results.
Diego Armando Hernández-Domínguez
Medical Oncology Service of the Hospital General León Secretary of Health, León Guanajuato, Mexico
Fernando Aldaco-Sarvide
Medical Oncology Service of the National Medical Center November 20, ISSSTE, Mexico City, Mexico
Guadalupe Cervantes-Sánchez
Medical Oncology Service of the National Medical Center November 20, ISSSTE, Mexico City, Mexico
Laura Torrecillas-Torres
Medical Oncology Service of the National Medical Center November 20, ISSSTE, Mexico City, Mexico
Analeticia Mendoza Balderas
Department of Epidemiology, Secretary of Health of Guanajuato, Guanajuato Mexico
Abstract
Melanoma is the skin tumor with the highest morbidity and mortality with highly variable incidence rates that depend mainly on genetic-population, geographical and behavioral factors 1. In our country we do not have a specialized, unified and vast oncology registry system that allows us to evaluate the historical behavior of neoplasms (incidence, prevalence and mortality) and our actions as health professionals. Previous information from different authors on melanoma mortality in Mexico coincides with an increase in mortality in the different historical contexts analyzed; this article updates the data from 2016, where a continuous increase in mortality was documented 2.
Objective: To know the evolution of melanoma mortality in the last 23 years in Mexico from 1998 to 2020.
Methods: The official information on melanoma mortality available in the dynamic cubes of the National System of Basic Information on Health (SINBA) and the National Institute of Statistics and Geography (INEGI) was reviewed. The population estimates and projections were obtained from the National Population Council (CONAPO); the number of patients affiliated with the main health systems was obtained directly from the official electronic pages available from each institution and from INEGI.
Findings: The general mortality rate due to melanoma in Mexico has increased by 71%, from 0.32*105 inhabitants in 1998 to 0.54*105 inhabitants in 2020, being the highest registered 0.61*105 in 2018 and since then with a tendency to stabilize and decline. Currently, the state with the highest mortality rate is Zacatecas with 0.90*105 and the lowest is reported in the state of Guerrero with 0.11*105. In terms of age groups, the most affected by this neoplasm is that of 60 years and over with a rate of 3.42*105 and the group of 0 to 29 years represents the lowest rate of 0.02*105. Regarding sex, mortality is higher for men with a rate of 0.60*105 and women 0.48*105.
Interpretation: Melanoma mortality in Mexico has increased constantly for 21 consecutive years from 1998 to 2018, registering in this last year (2018) the historically highest mortality rate in our country. It should be noted that in the last two years of analysis in this study (2019 and 2020) the mortality rate has not increased, presenting a tendency to stabilize and decrease; this is something that had not occurred in the period of time studied and this fact is encouraging; In addition, this phenomenon may be influenced by the incorporation in the recent past of some innovative molecules in certain health systems and hospitals that were not previously available, and greater participation of our country in clinical trials.
David G. Hoel
Dept of Public Health Sciences, Medical University of South Carolina, Charleston South Carolina, 29401
Abstract
There has been considerable debate concerning melanoma risk associated with the use of commercial tanning salons. In this review we examine the current state of the scientific evidence on this subject as well as whether use of tanning salons confers any health benefit. We conclude that there is no persuasive evidence that use of commercial tanning salons is associated with increased risk of melanoma, that there is significant evidence that use of commercial tanning salons is associated with decreased risk of melanoma, and that use of commercial tanning salons confers a significant health benefit.
Daleep Kumar, Consultant General Surgeon
Department of Surgery, Dow Medical College, DUHS, Karachi, Pakistan
Aun Ali, Associate Professor
Department of Surgery, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Karachi, Pakistan.
Summaya Saeed, Associate Professor
Department of Surgery, Dow International Medical College, DUHS, Karachi, Pakistan
Khursheed Ahmed Samo, Associate Professor
Department of Surgery, Dow Medical College, DUHS, Karachi, Pakistan
Madeeha Shahid, Senior Registrar
Department of Surgery, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Karachi, Pakistan.
Rubab Nafees, Consultant General Surgeon
Department of Surgery, Dow Medical College, DUHS, Karachi, Pakistan
Abstract
BACKGROUND: Anorectal melanoma (ARM) is an extremely rare, highly aggressive form of a tumor with the worst prognosis. ARM contributes 0.5% of all melanoma cases. Its presentation is similar to that of adenocarcinoma of the rectum, hemorrhoids, or solitary rectal ulcer, the incorrect clinical diagnosis or delayed diagnosis is often made. The definite diagnosis is only made through histopathology in which immunohistochemical stains positive to S-100, Melan A, and HMB-45 which differentiates it from adenocarcinoma of the rectum.
Because of the limited number of patients and retrospective design of studies to date, there is no proven efficacy of abdominoperineal resection (APR) over local excision (LE) in terms of survival. Furthermore, this neoplasm is quite resistant to chemoradiotherapy. It has a median survival of 18 months and a 5-year survival rate of only 6%.
PRESENTATION OF OUR CASES: Here, we report 5 rare cases of anorectal malignant melanoma presented to our institute between 2018 to 2022, who were treated with APR and diversion colostomy. The first case is a 27-years old young female with typical complaints, she was diagnosed ARM with locoregional metastasis. Only a diversion colostomy was performed and referred to an oncologist for palliation. Our second case is a 68-years old male with a similar complaint who presented relatively early and was diagnosed with localized disease. Conventional APR was performed and referred for adjuvant chemoradiotherapy, but the patient refused. However, the lump recurred after 6 months of tumor excision. The third case is a 29 years old male again early presentation with a similar complaint labeled as localized diseased. The conventional APR was performed followed by adjuvant chemoradiation; patient presented with metastatic disease after 6 months. The fourth case is a 60-years old male with typical history and diagnosed with localized disease. Conventional Extra-levator APR was performed followed by adjuvant therapy, but patient developed recurrence of disease with mets after 4 months. The fifth case is a 39-years old female diagnosed as ARM, had advance disease and metastatic deposits at the time of presentation, refused any palliative treatment. The study aims to evaluate our experience in treating this neoplasm.
CONCLUSION: Because of the rarity of this neoplasm, no proper trial has been conducted so far. The role of chemoradiotherapy is questionable and the surgical approach varies from radical APR to conservative LE. No surgical approach has been standardized in terms of survival.
Coelho JC
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre ;Grupo Oncoclinicas Porto Alegre
Pereira RP
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre;Grupo Oncoclinicas Porto Alegre
Cassol EP
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre
Andrade GT
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre ;Grupo Oncoclinicas Porto Alegre
Zanon AB
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre
Gatto G
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre
Liedke PER
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre ;Grupo Oncoclinicas Porto Alegre
Azevedo SJ
Pesquisa Clínica em Oncologia (UPCO) – Hospital de Clínicas de Porto Alegre; Grupo Oncoclinicas Porto Alegre; Departamento de Medicina Interna, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul
Abstract
The contemporaneous treatment of cutaneous metastatic melanoma (CMM) has been revolutionized in a process started decades ago with the better understanding of cancer genetics, cancer biology and the functioning mechanisms of the immune system, which were more recently translated from basic and clinical research into efficacious and effective new drugs. At the turn of the 21st century, patients with CMM had very few treatment options and their survival was measured in few months. Traditional chemotherapy or cytotoxic drugs had very limited non curative potential, with OS in the ranging from 6 to 12 months, at best.
Currently, the use of immune check point inhibitors (ICIs) and drugs directed at blocking mutated BRAF gene proteins as well as MEK inhibitors have transformed the landscape of CMM treatment, with immense positive impact on hard surrogates such as overall survival (OS) and disease-free survival (DFS) and on the quality of life (QoL) of such patients.
Our objective here is to review the last ten years of data regarding this evolution, as well as acknowledging its pitfalls and limitations, while trying to look forward in the search for biomarkers that could better tail treatment choices while preventing unnecessary toxicities.
David John Mackay Smith
University of Queensland, Brisbane, Australia.
Abstract
The keratinocyte and the melanocyte, the main cellular constituents of the epidermis, are two very different cell types. Despite their different origins and functionality, they come together in the skin, synergistically, to function as a unit to control the adverse effects of solar exposure. The most significant element in this protective process is the ability of the melanocyte to produce melanin. This pigmented polymer is responsible for constitutive skin colour that plays a part in our identity as human individuals but more importantly, provides a tanning response. A change in pigmentation that provides both an immediate and prolonged protective effect from the damaging components of solar radiation.
The melanocortin 1 receptor, a cell surface receptor on the melanocyte, receives paracrine stimulation in the form of hormonal communication from the keratinocyte, initiating a series of intracellular molecular interactions in the melanocyte, eventually involving transcription factors in the nucleus, most notably the microphthalmia-associated transcription factor, resulting in upregulation of enzymatic production of melanin and finally, its transfer back to the keratinocyte.
The melanocortin 1 receptor is highly polymorphic and unfortunately this results in the Caucasians’ having constitutionally fairer skin combined with an incomplete tanning response, resulting in a higher susceptibility to skin cancer.
The melanocyte is a relatively long-lived cell and over its extended life span can accumulate a series of mutational events. With malignant transition to melanoma this oncogenic baggage, when combined with antiapoptotic machinery that helps melanocyte survival, resulting in relatively rapid progression of the malignant process and contributing to its resistance to therapeutics.
David John Mackay Smith
University of Queensland
Abstract
Approximately 10% of genes oscillate according to a circadian clock. Even though cells are capable of independent oscillation there is a master controller in the brain, the suprachiasmatic nucleus (SCN), that provides a coordinated response throughout the body, influenced by daily and seasonal patterns of light and heat. These genes have widely varied functions but are significantly influential in DNA damage repair, the cell cycle, cellular proliferation and apoptosis, as well as metabolic function. Normal circadian rhythms are essential for the body’s natural defence against disease and cancer. Deregulation may enhance the capacity for carcinogenesis in the skin and the influence of the circadian clock helps explain two of the anomalies of melanoma exposure patterns: A higher incidence amongst indoor as opposed to outdoor workers and on intermittently as opposed chronically exposed skin.
Tyler R. Harrison
Department of Communication Studies, University of Miami, Coral Gable, Florida, USA
Jessica Wendorf Muhamad
School of Communication, Florida State University, Tallahassee, Florida, USA
Ekaterina Malova
Simon Business School, University of Rochester, Rochester, New Yor, USA
Abstract
Objective: This paper provides a review of current knowledge and trends in research on firefighters cancer risks and risk reduction efforts and calls for future research focused on European and international firefighters to understand and reduce occupational cancer risk.
Cancer incidence: Firefighters face increased occupational cancer risk. Firefighting has been linked with multiple types of cancer, including bladder, colorectal, brain and central nervous system, non-Hodgkin’s lymphoma, skin melanoma, and prostate and testicular cancer, with several others types of cancer being found at increased rates.
Cancer risks: Increased occupational cancer risk is, in part, related to carcinogenic exposures at fire events and improper use and cleaning of personal protective equipment (PPE), with role and years in service increasing risk.
Risk Perception: Research on efforts to reduce cancer risk are growing, and include examination of firefighter knowledge, attitudes, norms, and behaviors toward decontamination, screening, and healthy eating. Many firefighters report high perceived susceptibility and severity of cancer risk, and identify fire scene exposures, contaminated gear, diet, sleep disruption, chemical exposure from cleaning products, and barriers to medical care as contributing to increased risk.
Risk Reduction: Firefighters have strong desire to reduce cancer risk and report generally favorable attitudes toward decontamination practices and proper gear use, but face barriers to reducing those risks, including lack of knowledge, occupational needs, organizational culture, policy, and lack of resources. Behavioral interventions to reduce cancer risk through decontamination efforts and dietary change have demonstrated positive results, however there is a dearth of research on these efforts, especially with European and international firefighters.
Future Directions: Future research should focus on understanding European and international firefighters’ knowledge, attitudes, and behaviors toward cancer risk reduction, the impact of the built environment on cancer risk (station layout, clean cabs), improved efforts at tracking exposures, use of new technology and virtual reality in training to reduce cancer risk, and improved understanding of firefighter cancer risk by medical professionals.
Ümit Deniz GÖKER
Associate Professor (Senior Researcher at Czech Academy of Sciences)
Abstract
Pilots who have completed successfully all the tests of cognitive and personality psychology have a strong commitment to their movements, and they influence their neural stimulation, such as the ability to acknowledge the right steps to follow in their tasks or dangerous situations. One of the branches of Aviation Psychology is dealing with the physical and mental effects of flight on aircrew personnel and passengers. Astronomical events, such as geomagnetic storms (GSs) that have a disruptive effect on Earth’s magnetosphere in certain periods, will cause negative effects on aircrew personnel and passengers. This article describes the expected damage to the different areas of the brain and nervous system in short- and long-term periods caused by the effects of GSs, based on the results of previous studies on GSs and neurophysiological studies. This is a very important topic for neurophysiological studies of pilots when we consider that aircraft accidents that may be geomagnetic in origin accounted for 26.36% of the total accidents which coincide with the days of GSs. Decision-making and judgment problems, abnormal attitudes such as anger, fearlessness, temerity, self-confidence, etc., decreasing problem-solving abilities, organization capabilities, and instantaneous decisions are the short-term changes while developing cancers of the brain, testis, bladder, breast, colon, melanoma, and Hodgkin’s type, in addition to Alzheimer’s and dementia diseases, hypoglycaemia, stroke, epileptic seizures, insomnia, stomach bleeding, appendicitis, hernia, asthma, and severe spinal pains can be lead in the long-term changes. We mentioned the psychological and medical application method of EEG in our article since it is the best technique that allows us to see the effects of these storms in the laboratory environment. This is because, the aircrew personnel and passengers flying at high latitudes will experience the effect of the GSs directly, whereas the response of the pilot, flight crew, and passengers flying in the middle latitudes, to these effects, can be measured only with tests in the laboratory environment. This paper has also special importance for the aviation literature because a theoretical recommendation regarding the possible laboratory environment for EEG measurements and application procedures necessary to investigate these effects is also presented.
Abstract
Background: Several studies of the health problems incurred by flight attendants flying during the smoking years concluded that they suffered elevated rates of chronic bronchitis, heart disease, skin cancer, breast cancer, melanoma, reproductive cancers, middle ear infections, hearing loss, asthma, pneumonia, chronic obstructive pulmonary disease, various pulmonary function abnormalities, plus depression and anxiety.
Aims: Systematic review of secondhand smoke risks to flight attendants, exemplified using a specific case involving a deceased flight attendant who suffered from a multiplicity of tobacco-smoke-related diseases, including asthma, breast cancer, carotid artery stenosis, cataracts, cervical cancer, chronic obstructive pulmonary disease, coronary artery disease, laryngeal cancer, pneumonia and chronic myeloid leukemia. The decedent died in 2014 at age 68, losing an estimated 18.5 years of life expectancy.
Methods: Pharmacokinetic modeling was used for the first time to estimate the risk from secondhand smoke for flight attendants on typical passenger aircraft flown by the decedent during an 18 year period ending in 1988.
Results: Based on in-flight cotinine dosimetry measured in an Air Canada study, typical flight attendants would have inhaled a dose-equivalent of fine particle air pollution exceeding the “Air Pollution Emergency” levels of the U.S. Environmental Protection Agency’s Air Quality Index. The secondhand smoke cotinine dose for typical flight attendants in aircraft cabins is estimated to have been 6-fold that of the average US worker and 14-fold that of the average person. Thus, ventilation systems massively failed to control secondhand smoke air pollution in aircraft cabins, and led to extreme exposures. The decedent’s estimated lifetime cancer risk from secondhand smoke was 18 times U.S. OSHA’s Significant Risk of Material Impairment of Health level of 1 per 1000 per working lifetime.
Conclusions: In-flight exposure to toxic and carcinogenic tobacco smoke in smoky passenger cabins was the major risk factor leading to the decedent’s multiple smoking-related diseases, and her premature death. This has implications for the extant and future health of the cohort of surviving flight attendants exposed to secondhand smoke on aircraft during the 20th Century Era.
Abstract
Psoriasis, a chronic immune-mediated skin disorder impacting millions globally, is increasingly recognized for its links to various disease processes. As our understanding of immune dysregulation in psoriasis progresses, acknowledging the pivotal role of dysregulated T-cells in the pathogenic development of the persistent inflammatory state becomes crucial. This immune dysregulation and the resulting prevalent inflammatory state have raised concerns about psoriasis potentially serving as a significant comorbidity in cancer development among patients. To contribute to this discussion, we conducted a global retrospective cohort study with propensity score matching (PSM) using the TriNetX Analytics platform. The study aimed to investigate whether patients diagnosed with psoriasis face an elevated risk in the development of cutaneous malignancies, encompassing both melanoma and non-melanoma skin cancers. Our findings confirmed a noteworthy concern, revealing a significantly increased risk of developing cutaneous neoplasms in individuals with psoriasis. In conclusion, our study underscores the importance of heightened awareness and the necessity for routine skin cancer screenings in this unique patient population. The observed association between psoriasis and an increased risk of cutaneous neoplasms highlights the need for proactive medical interventions and emphasizes the potential impact of psoriasis as a comorbidity in the context of cancer development.
David John Mackay Smith
University of Queensland, St Lucia QLD 4072, Australia
Abstract
Public health messages clearly state the risks of solar radiation and how the risk can be mitigated. This is supported by the availability of creams that effectively block out the ultraviolet component of solar radiation. Why then does the incidence of skin cancer and particularly melanoma remain so disturbingly high in Caucasian populations?
Almost all organisms on the planet have had to adapt to the presence of solar radiation since the beginning of evolutionary time. There are beneficial effects as well as risks in exposure, not the least of which is that it is the ultimate energy source for living species.
We need to re-examine attitudes and exposure patterns with an appreciation that some exposure is essential for good health. A balance needs to be found between benefits and risks. This can only be done by understanding that there are a range of wavelengths of light with different effects rather than a focus solely on the adverse effects of the ultraviolet component.
C DeGiovanni
Department of Dermatology, University Hospitals Sussex NHS Foundation Trust. Brighton General Hospital, Elm Grove, Brighton, BN2 3EW. United Kingdom
M Patel
Department of Dermatology, University Hospitals Sussex NHS Foundation Trust. Brighton General Hospital, Elm Grove, Brighton, BN2 3EW. United Kingdom
P Drake
Department of Dermatology, University Hospitals Sussex NHS Foundation Trust. Brighton General Hospital, Elm Grove, Brighton, BN2 3EW. United Kingdom
P Sains
SainsSurgical. 4 Elsworthy, Thames Ditton, Surrey, KT7 0YP
V Sridhar
Osney thermo-fluids laboratory, Department of Engineering Science, University of Oxford. Oxford. OX1 3PJ
Kam Chana
Osney thermo-fluids laboratory, Department of Engineering Science, University of Oxford. Oxford. OX1 3PJ
Abstract
Skin cancer is one of the most common cancers in the world. Skin cancer is currently a global public health problem that is escalating. In the UK, the incidence of malignant melanoma has increased from 837 per year to 6963 per year in males and 1609 per year to 6952 per year in females between 1981 and 2018. Early diagnosis and treatment, as with any other disease will have a positive outcome in terms of survival and costs of management. Advances in technology have allowed the development of tools that provide rapid and sensitive diagnosis of many diseases. This paper describes the development and use of a thermal based technique which directly measures the thermal properties of skin. The Thermal Product Sensor (TPS), a new biosensor, has been demonstrated in the diagnosis of skin malignancies. The technique is quantitative and is shown to distinguish between normal and malignant skin. The study demonstrates on 12 patients the thermal product technique successfully detected skin cancers in comparison to normal skin.
Frederick H. Silver
Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, Piscataway, NJ 08854; OptoVibronex, LLC., Allentown, Pa
Tanmay Deshmukh
OptoVibronex, LLC., Allentown, Pa
Nicole Ryan
Dermatology, Summit Health, Berkeley Heights NJ 07922
Arielle Romm
Dermatology, Summit Health, Berkeley Heights NJ 07922
Hari Nadiminti
Dermatology, Summit Health, Berkeley Heights NJ 07922
Abstract
Vibrational optical coherence tomography (VOCT) has been used to non-invasively measure the resonant frequency and elastic modulus of different types of BCCs to compare the physical biomarker characteristics of each of these lesions. The results suggest that in very small lesions (about 0.05 mm in diameter) new 80Hz and 130Hz resonant frequency peaks are seen not present in normal skin or in healing wounds. In all other BCCs, new 80Hz, 130Hz and 260Hz resonant frequency peaks are found like those found in other carcinomas including SCC and melanoma.
Small BCCS are characterized by new 80Hz and 130Hz in the absence of a significant 50Hz peak unlike actinic keratoses that are characterized by 50Hz, 80Hz and 130Hz peaks. In the absence of the 260Hz peak, small BCCs appear to be a precursor to larger BCCs. Pigmented BCCs exhibit a larger ratio of the 50Hz/80Hz peaks compared to the other BCC types in addition to peaks at 130Hz and 260Hz suggesting that benign melanocyte lesions contribute to the 50 Hz peak. Further studies are needed to understand the factors that drive differences in shape and invasiveness of cancerous BCCs.
While all BCCs were found to contain new cell and blood vessel resonant frequencies that coincide with fibrotic tissue encapsulating the tumors in the papillary dermis, other factors must drive differences in the shape and invasiveness of the different BCCs. It is hypothesized that the new cells and blood vessels formed lead to the deposition of fibrous tissue in all BCCs and is partially driven by an epithelial-mesenchyme transition. It is concluded that fibrotic tissue is found encapsulating all cancerous BCCs and that this layer of tissue may limit invasiveness and metastatic behavior of this tumor type. In general, tumor shape and invasiveness are likely influenced by the exact cellular mutations in each lesion type and the extent of UV light damage experienced by the surrounding extracellular matrix.
Joseph C. DiNardo
MS Toxicologist
Abstract
Although the safety and efficacy of ultraviolet filters (sunscreens) is widely accepted by consumers and medical professionals, the scientific community has yet to validate this conclusion. This is evident based on multiple literature searches obtained from PubMed, Google Scholar, ScienceDirect, ResearchGate, sunscreen manufacturers and dermatologic organization websites. In the absences of definitive data, industry continues to promote the use of these products to prevent cancers, specifically a 40% reduction in squamous cell carcinoma and a 50% reduction in melanoma based on one confounded non-reproduced study with numerous design flaws. This causes consumers to be misinformed leading them to intentionally increase ultraviolet light exposure, increasing their risk of skin cancers. Until the scientific community can clearly demonstrate that these products reduce/eliminate skin cancers, consumers should follow sun avoidance measures.
