UV radiation (UV) is classified as a "complete carcinogen" because it is both a mutagen and a non-specific damaging agent and has properties of both a tumor initiator and a tumor promoter. In environmental abundance, UV is the most important modifiable risk factor for skin cancer and many other environmentally-influenced skin disorders. However, UV also benefits human health by mediating natural synthesis of vitamin D and endorphins in the skin, therefore UV has complex and mixed effects on human health. Nonetheless, excessive exposure to UV carries profound health risks, including atrophy, pigmentary changes, wrinkling and malignancy. UV is epidemiologically and molecularly linked to the three most common types of skin cancer, basal cell carcinoma, squamous cell carcinoma and malignant melanoma, which together affect more than a million Americans annually. Genetic factors also influence risk of UV-mediated skin disease. Polymorphisms of the melanocortin 1 receptor (MC1R) gene, in particular, correlate with fairness of skin, UV sensitivity, and enhanced cancer risk. We are interested in developing UV-protective approaches based on a detailed understanding of molecular events that occur after UV exposure, focusing particularly on epidermal melanization and the role of the MC1R in genome maintenance.

/pdf/uv-radiation-and-the-skin-2ub2qrbyk1.pdf

UV Radiation and the Skin

Skin cancer is the most common type of cancer in fair-skinned populations in many parts of the world. The incidence, morbidity and mortality rates of skin cancers are increasing and, therefore, pose a significant public health concern. Ultraviolet radiation (UVR) is the major etiologic agent in the development of skin cancers. UVR causes DNA damage and genetic mutations, which subsequently lead to skin cancer. A clearer understanding of UVR is crucial in the prevention of skin cancer. This article reviews UVR, its damaging effects on the skin and its relationship to UV immunosuppression and skin cancer. Several factors influence the amount of UVR reaching the earth's surface, including ozone depletion, UV light elevation, latitude, altitude, and weather conditions. The current treatment modalities utilizing UVR (i.e. phototherapy) can also predispose to skin cancers. Unnecessary exposure to the sun and artificial UVR (tanning lamps) are important personal attributable risks. This article aims to provide a comprehensive overview of skin cancer with an emphasis on carefully evaluated statistics, the epidemiology of UVR-induced skin cancers, incidence rates, risk factors, and preventative behaviors & strategies, including personal behavioral modifications and public educational initiatives.

https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-4632.2010.04474.x

Ultraviolet radiation and skin cancer.

Recent advancements in natural dye applications: a review

The international American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumour-node-metastasis (TNM) staging system provides the current guidelines for the classification of cancer. However, among patients within the same stage, the clinical outcome can be very different. More recently, a novel definition of cancer has emerged, implicating at all stages a complex and dynamic interaction between tumour cells and the immune system. This has enabled the definition of the immune contexture, representing the pre-existing immune parameters associated with patient survival. Even so, the role of distinct immune cell types in modulating cancer progression is increasingly emerging. An immune-based assay named the 'Immunoscore' was defined to quantify the in situ T cell infiltrate and was demonstrated to be superior to the AJCC/UICC TNM classification for patients with colorectal cancer. This Review provides a broad overview of the main immune parameters positively or negatively shaping cancer development, including the Immunoscore, and their prognostic and predictive value. The importance of the immune system in cancer control is demonstrated by the requirement for a pre-existing intratumour adaptive immune response for effective immunotherapies, such as checkpoint inhibitors. Finally, we discuss how the combination of multiple immune parameters, rather than individual ones, might increase prognostic and/or predictive power.

The immune contexture and Immunoscore in cancer prognosis and therapeutic efficacy.

Photo-induced damage to proteins occurs via multiple pathways. Direct damage induced by UVB (λ 280–320 nm) and UVA radiation (λ 320–400 nm) is limited to a small number of amino acid residues, principally tryptophan (Trp), tyrosine (Tyr), histidine (His) and disulfide (cystine) residues, with this occurring via both excited state species and radicals. Indirect protein damage can occur via singlet oxygen (1O21Δg), with this resulting in damage to Trp, Tyr, His, cystine, cysteine (Cys) and methionine (Met) residues. Although initial damage is limited to these residues multiple secondary processes, that occur both during and after radiation exposure, can result in damage to other intra- and inter-molecular sites. Secondary damage can arise via radicals (e.g. Trp, Tyr and Cys radicals), from reactive intermediates generated by 1O2 (e.g. Trp, Tyr and His peroxides) and via molecular reactions of photo-products (e.g. reactive carbonyls). These processes can result in protein fragmentation, aggregation, altered physical and chemical properties (e.g. hydrophobicity and charge) and modulated biological turnover. Accumulating evidence implicates these events in cellular and tissue dysfunction (e.g.apoptosis, necrosis and altered cell signaling), and multiple human pathologies.

https://link.springer.com/content/pdf/10.1039/c1pp05164d.pdf

Photo-oxidation of proteins

Melanoma is the deadliest form of all skin cancers and is highly linked to sun-related behavior in patients. However, sun-protection behavior to prevent melanoma in this population has been shown to be inadequate to date. The objective of this study was to compare changes in sun protection habit before and after patients' diagnosis with malignant melanoma. The study also seeks patients' advice on how to improve public education on melanoma prevention. A retrospective survey study was conducted on 68 respondents of patients diagnosed with melanoma from six different dermatologic practices in various boroughs of New York and Long Island in the state of New York by telephone interviews. There was a significant positive change in patients' sun-protection behavior after they were diagnosed with melanoma. Various methods of sun protection, such as avoiding sun exposure, applying and reapplying sunscreen, and wearing protective clothing were practiced more frequently after diagnosis. In addition, the frequency of sunbathing decreased drastically. Most patients were aware about the dangers of sun exposure before their diagnosis. They, however, did not feel the need to adopt sun-protection measures before their diagnosis. Respondents advised that education on dangers to excess sun exposure should be provided at an early age through multiple venues. The study reflected that 71% of diagnosed patients who completed the survey were informed about sun protection before their diagnosis. Many patients did not follow strict guidelines to prevent sun damage as shown by their behaviors before diagnosis. Diagnosis of the disease was apparently the main motivating factor to initiate challenging behavioral changes.

Behavioral factors of patients before and after diagnosis with melanoma: a cohort study - are sun-protection measures being implemented?

Summary

Background Botulinum toxin (BTX) therapy is currently the most popular cosmetic procedure in the United States. However, few studies exist regarding post-procedure perceptions of the patients’ BTX therapy.



Objective  The aim of this cohort study was to determine patients’ responses from pre- to post-BTX treatment experience.



Methods and materials  One hundred twenty-three BTX patients of six different dermatologic cosmetic practices in various boroughs of New York and Long Island in the state of New York completed the questionnaire. Six hundred eighty-three surveys were sent out, and 123 completed surveys were obtained. Numerous questions were asked regarding how patients felt and responded towards the overall procedure of their BTX therapy.



Results  Eighty-eight percent of patients were satisfied or extremely satisfied with their dermatologists. Sixty-five percent of patients felt over 60% improvement in areas treated. Fifty-eight percent of patients anticipated making repeat visits, whereas the biggest concern for returning was due to the expensive cost of BTX.



Conclusion  Our study correlated with previous studies done on retention rate of BTX cosmetic patients and satisfaction level on areas treated. The cost of BTX remained one of the primary concerns for repeat visits. Most patients were happy with their visits to the dermatology offices for BTX procedure, although things can be done to further enhance their visits and the likelihood that they will return.

Cohort study on patient response to botulinum toxin cosmetic therapy.

Background Platelet-rich plasma is highly enriched plasma that contains a large concentration of platelets that secrete various growth factors and is used in a wide variety of surgical and cosmetic procedures, including hair regrowth and skin rejuvenation. Methods Microneedling therapy is being combined with platelet-rich plasma to potentiate patient's cosmetic effects. While microneedling therapy and platelet-rich plasma therapy have been around for years and are growing in popularity internationally, there are limited data regarding complications when they are used in conjunction. Results We present a case in which a patient presented with acute, painful lymphadenopathy shortly after undergoing the combination treatment of a microneedling pen with platelet-rich plasma therapy. Conclusion Individuals should know of the potential adverse effect of microneedling pen therapy used in conjunction with platelet-rich plasma therapy, and it should be included in patient consent forms and doctor-patient education.

Cervical lymphadenopathy from PRP treatment with microneedling therapy.

To the Editor:Angiolipoma is a slow-growing, benign tumor containing vascular and mature adipose elements. Common treatment for angiolipomas has been surgical removal, which is often expensive and leaves undesirable scarring. A 35-year-old pregnant woman was referred to our practice for multiple subcutaneous lesions appearing on the right and left anterior thighs. Thirteen tender and painful nodules were identified ranging in diameter from 1 to 4 cm with no discoloration (figure 1). The patient denied taking any medication, ruling out the possibility of allergic reaction, and denied a family history of such a condition or any trauma to the area. Histopathologic examination of the lesion revealed a lobular mass of mature adipose cells surrounded by a thin connective tissue with the presence of small blood vessels consistent with angiolipoma. As a result of her pain, pregnancy, and multiple lesions, the patient requested a non-invasive therapy. Considering the patient request, one test nodule was selected and treated with intralesional triamcinolone 5mg/mL in bacteriostatic water, yielding dramatic positive results with the pain disappearing within 1–2 days and a noticeable decrease in the size of the lesions. Two weeks later, the remaining 12 lesions were treated yielding excellent results. One-year post-treatment, the patient reported an 85% decrease in the size and pain of the lesions. We present a similar case of a 53-year-old man with numerous fatty and intermittently painful lesions on the stomach and right arm. The patient denied a family history of the condition or that the area had experienced trauma, and he was not onmedication. As a result of themultiple lesions, the patient opted for a medical therapy other than surgery. Six of the nodules were treated with intralesional triamcinolone acetonide 5mg/kg in bacteriostatic water. One to two days posttreatment, the patient reported a significant reduction in size and a decrease in the painful irritating sensation with overall 60% improvement of the condition. One-year post-treatment, neither patient has reported a recurrence of symptoms or any complication such as atrophy. Standard treatment for non-infiltrating angiolipomas is total surgical removal. Surgical excision is curative, and there is no evidence of malignant transformation. Because of the presence of multiple lesions, and the desire to avoid scars our patients requested non-excisional corticosteroid injections. It is postulated that corticosteroid injections result in local fat atrophy, thus shrinking the lipoma. Another possible mechanism for the corticosteroid effect may be changes in endorphin levels. Triamcinolone 5mg/mL in bacteriostatic water was injected into the center of each lesion. The volume of corticosteroid injected depends on the size of the lipoma, with an average of 0.3–0.5mL of total volume administered per angiolipoma. The number of injections depends on the site and the response desired. Improvement is expected to occur within 3–4 weeks. Rare complications, which we did not see in our cases, include atrophy, skin sensitivity, hyporpigmentation, bruising, and hematoma. These side effects may be prevented

Joshua L. Fox

Papers

Ultraviolet radiation and skin cancer.

Behavioral factors of patients before and after diagnosis with melanoma: a cohort study - are sun-protection measures being implemented?

Cohort study on patient response to botulinum toxin cosmetic therapy.

Cervical lymphadenopathy from PRP treatment with microneedling therapy.

Two cases of multiple angiolipoma treated with intralesional triamcinolone.