Measures of Cumulative Exposure from a Standardized Sun Exposure History Questionnaire: A Comparison with Histologic Assessment of Solar Skin Damage
|
|
- Meredith Thompson
- 5 years ago
- Views:
Transcription
1 American Journal of Epidemiology Copyright ª 2007 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A. Vol. 165, 6 DOI: /aje/kwk055 Advance Access publication January 4, 2007 Practice of Epidemiology Measures of Cumulative Exposure from a Standardized Sun Exposure History Questionnaire: A Comparison with Histologic Assessment of Solar Skin Damage Margaret R. Karagas 1, Michael S. Zens 1, Heather H. Nelson 2, Kiyohiko Mabuchi 3, Ann E. Perry 4, Therese A. Stukel 5, Leila A. Mott 1, Angeline S. Andrew 1, Katie M. Applebaum 2, and Martha Linet 3 1 Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, and the Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, NH. 2 Department of Environmental Health, Harvard School of Public Health, Boston, MA. 3 Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD. 4 Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, NH. 5 Institute for Clinical Evaluative Sciences, Toronto, Canada. Received for publication April 14, 2006; accepted for publication August 22, Ultraviolet radiation exposure is the dominant environmental determinant of all major forms of skin cancer; however, the nature of the association is incompletely understood. Existing instruments to capture sun exposure history tend to yield reproducible results, but the validity of these responses is unknown. To address this question, the authors examined the relation between responses to a standardized sun exposure instrument and histologic evidence of actinic damage in a population-based study of keratinocyte cancers from New Hampshire diagnosed from July 1, 1997, through March 31, A single study dermatopathologist histologically reviewed the adjacent skin of 925 skin cancer biopsies for the presence of solar keratoses and the extent of solar elastosis. The authors compared these measures with responses to a personal interview on history of sunburns, sunbathing, and time spent outdoors. Focusing on site-specific exposure, they found variables that estimated cumulative exposure related to histologic evidence of actinic damage. In contrast, measures of acute/intermittent exposure were generally unrelated to solar damage histologically. Findings suggest that cumulative, but not intermittent, measures of sun exposure derived from a personal interview appear to reflect a person s exposure history based on histologic evidence. case-control studies; questionnaires; skin neoplasms; ultraviolet rays; validation studies Abbreviations: BCC, basal cell carcinoma; SCC, squamous cell carcinoma; UVR, ultraviolet radiation. Ultraviolet radiation (UVR) exposure plays a major role in the etiology of all major forms of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma; however, the nature of the association is incompletely understood (1). SCC relates primarily to measures of cumulative exposure, but some studies suggest that, similar to melanomas, BCC in particular may be caused by lower levels of intense, intermittent sun exposure (i.e., recreational) and by exposure during childhood (2 4). Additionally, risks of both SCC and BCC may be affected by recent sun exposure (2, 5). Standardized interview instruments to estimate sun exposure history attempt to capture time spent outdoors during daylight hours throughout a person s lifetime during both recreational and occupational activities. Furthermore, they gather information regarding specific sun exposure behaviors such as frequency of sunbathing. Although these instruments tend to yield reproducible results (4, 6), there are Correspondence to Dr. Margaret R. Karagas, Dartmouth Medical School, Section of Biostatistics and Epidemiology, 7927 Rubin Building, One Medical Center Drive, Lebanon, NH ( margaret.karagas@dartmouth.edu). 719
2 720 Karagas et al. TABLE 1. Association of anatomic site and age with the presence of solar keratoses* and severe solar elastosis among men and women residents of New Hampshire aged 25ÿ74 years diagnosed from July 1, 1997, through March 31, 2000 Characteristic a number of challenges to eliciting responses. Among them is the length of the interview, typically about 45 minutes per subject for the sun exposure history component alone. In addition, the responses result in more than 100 possible variables. Selection of the relevant analytic variables is especially problematic in light of the virtual absence of data on the validity of the instruments in capturing a person s sun exposure; that is, responses to the standardized questions on sun exposure history have not been compared with objective measures of actinic damage. Presently, differences in the accuracy of sun exposure responses among men and women remain unknown even though their patterns of exposure differ (i.e., men have more opportunities than women for occupational UVR exposure). Understanding the validity of sun exposure questionnaire responses would help to improve UVR exposure classification and in turn lead to more accurate and efficient characterization of UVR exposure assessment useful in future studies. For this reason, we sought to determine the sun exposure variables derived from a structured interview that best predict histologic evidence of actinic damage in men and women, using data collected as part of a populationbased case-control study of keratinocyte malignancies in New Hampshire. MATERIALS AND METHODS Study group Solar keratoses For the current study, we used the pathology materials from skin cancer cases selected to take part in our casecontrol study. To identify these cases, we enlisted the collaboration of dermatologists and pathology laboratories throughout New Hampshire and bordering regions (7). Briefly, we selected all invasive SCC cases, and, for efficiency, a roughly equal number of BCC cases (at random), diagnosed from July 1, 1997, through March 31, 2000, among New Hampshire residents aged years. We recruited 1,118 cases to take part and obtained the histologic materials from the original diagnostic tumor for 925 cases (83 percent) (443 BCC and 482 SCC). Interview data Severe solar elastosis Men (n ¼ 252) Women (n ¼ 149) Men (n ¼ 435) Women (n ¼ 313) ORy,z 95% CIy,z ORz 95% CIz ORz 95% CIz ORz 95% CIz Anatomic site Rest of body 47/ / / / Head and neck 94/ , / , / , / , 12.0 Reference age (years) 50 16/ / / / / , / , / , / , / , / , / , / , 6.8 >70 42/ , / , / , 5.5 7/ , 13.5 p for trend ¼ * Solar keratoses were limited to squamous cell carcinoma only. y OR, odds ratio; CI, confidence interval. z Adjusted for age and sex. Subject s age at diagnosis. p for trend ¼ p for trend ¼ p for trend < All participants provided informed consent in accordance with the Committee for the Protection of Human Subjects at Dartmouth College (Hanover, New Hampshire). Study participants completed a structured personal interview, usually at their homes. The interview included sociodemographic information (e.g., level of education), use of tobacco, and medical history (e.g., history of radiotherapy). To ascertain skin sensitivity to the sun, we asked subjects their usual skin reaction to sun exposure (i.e., tanning or burning), both acutely (first exposure of the summer for 1 hour) and after repeated and prolonged exposure to sunlight. Skin color was measured in both a sun-exposed (forearm) and an unexposed (underarm) area by using a Minolta CR200 colorimeter (Minolta Camera Co., Ltd., Osaka, Japan), for which 100 percent reflectance would represent pure white and 0 percent reflectance pure black for the parameter L. For hair color, subjects chose the color that corresponded with their natural hair color as a young adult (prior to graying or balding) from hair samples. Interviewers assessed eye color under natural light by using an eye photo chart and by self-report (as blue, green, gray, hazel, light brown, dark brown, or black). We used a modified version of the sun exposure questionnaire designed by Kricker et al. (8) for a previous populationbased, nonmelanoma skin cancer case-control study from
3 Measurement of Sun Exposure 721 TABLE 2. Association of pigmentary and other sun sensitivity characteristics with presence of solar keratoses and severe solar elastosis among New Hampshire residents aged 25ÿ74 years diagnosed from July 1, 1997, through March 31, 2000 Characteristic Solar keratoses (n ¼ 401) Severe solar elastosis (n ¼ 748) OR*,y 95% CI*,y ORy 95% CIy Skin color (underarm, colorimeter L)z Q*1 (29 <67) 69/ / Q2 (67 <69) 49/ , / , 2.4 Q3 (69 <71) 54/ , / , 1.3 Q4 (71 77) 44/ , / , 2.0 p for trend ¼ p for trend ¼ Natural hair color (matched to wig samples) Black 15/ , 1.4 8/ , 2.3 Dark brown 54/ (ref*) 48/ (ref) Light 66/ , / , 1.9 Blond 56/ , / , 1.5 Red 26/ , / , 2.6 p for trend ¼ p for trend ¼ Eye color (matched to eye photo chart) Brown or black 24/ / Green or hazel 46/ , / , 1.9 Blue or grey 148/ , / , 1.5 p for trend ¼ p for trend ¼ Sun sensitivity, first summer exposure Tan 19/ / Burn/tan 111/ , / , 1.2 Burn/peel 73/ , / , 0.9 Burn/blister 21/ , / , 1.0 p for trend ¼ p for trend ¼ Sun sensitivity, prolonged exposure Deep tan 41/ / Moderate tan 106/ , / , 1.3 Tend to peel 59/ , / , 1.8 No tan 18/ , / , 3.1 p for trend ¼ p for trend ¼ * OR, odds ratio; CI, confidence interval; Q, quartile; ref, reference. y Adjusted for age and sex (refer to the text). z Observed reflectance of underarm skin from a Minolta CR200 colorimeter (Minolta Camera Co., Ltd., Osaka, Japan), where, for the parameter L, 0 is black and 100 is white. Quartiles were established from the entire study population. Geraldton, Australia, and tested for its reproducibility (9). This instrument was derived from earlier skin cancer studies (10 13). First, subjects were sent a personal residence and work history calendar to complete prior to the interview. The calendar included the average number of days subjects worked and did not work in a given year. During the interview, the calendar was used to identify periods of consistent outdoor activities, then questions relating to time spent outdoors, sunbathing, and sunburns were asked for each of these periods. Questions included the amount of time spent outdoors: 1) from 9 a.m. to 5 p.m. and from 10 a.m. to 2 p.m., 2) on workdays and nonworkdays, and
4 722 Karagas et al. TABLE 3. Relation between measures of sun exposure and histologic evidence of solar keratoses and severe solar elastosis among New Hampshire residents aged 25ÿ74 years diagnosed from July 1, 1997, through March 31, ) in the summer and the rest of the year. For each period, subjects also were asked their frequency of sunbathing, number of painful sunburns (one that caused pain for 2 or more days), and number of blistering sunburns. Additionally, subjects were asked whether the anatomic site of the skin cancer was usually exposed and the number of sunburns at this site. For cases with multiple tumors at the time of diagnosis, we asked about the predominant site or a randomly selected site when multiple tumors occurred at the same site. Histopathologic assessment Exposure to specific anatomic site We requested the diagnostic pathology materials of skin cancers from the original pathology laboratory or dermatopathologist. The study pathologist verified the histologic Solar keratoses OR*,y 95% CI* Severe solar elastosis ORy 95% CI Measures of acute intense or intermittent exposure of lifetime painful sunburns 0 108/ / / , / , / , / , / , / , 1.3 p for trend ¼ p for trend ¼ Lifetime frequency of sunbathing Q*1 (0) 68/ / Q2 (1 226) 45/ , / , 1.2 Q3 ( ) 49/ , / , 1.0 Q4 (815 4,451) 57/ , / , 0.7 p for trend ¼ p for trend ¼ Proportion of lifetime hours spent outdoors recreationally, 9 a.m.ÿ5 p.m., warmer months Q1 (0 <0.5) 53/ / Q2 (0.5 <0.7) 48/ , / , 3.6 Q3 (0.7 <0.9) 42/ , / , 4.6 Q4 (0.9 1) 35/ , / , 1.2 p for trend ¼ p for trend ¼ Measures of cumulative exposure: time spent outdoors, 9 a.m. to 5 p.m., warmer months Total lifetime hours Q1 (0 <6,692) 44/ / Q2 (6,692 <12,044) 42/ , / , 7.5 Q3 (12,044 <18,345) 46/ , / , 8.4 Q4 (18,345 44,437) 46/ , / , 17.3 p for trend ¼ p for trend < Table continues diagnosis of the tumor and documented the extent of actinic damage in adjacent skin tissue. This procedure included assessment for the presence of solar keratoses (yes/no) defined by the presence of atypical epithelial cells confined to the epidermis. This atypia plausibly functions as a precursor event to SCC, and, because it does not typically appear in BCC, our assessment of this trait was limited to biopsies for SCC tumors. Presence of solar keratosis was determined for 401 (83 percent) of the biopsies for SCC. The extent of solar elastosis (mild, moderate, or severe) was based on the appearance and amount of abnormal elastotic fibers that putatively result from UVR penetration. Solar elastosis was categorized as mild if single, scattered, blue-gray elastotic fibers were identified in the papillary dermis. Moderate elastosis was characterized by clumps of elastotic fibers with intervening normal papillary dermis. Severe solar elastosis
5 Measurement of Sun Exposure 723 TABLE 3. Continued Exposure to specific anatomic site Solar keratoses OR*,y ORy 95% CI* Severe solar elastosis ORy 95% CI Lifetime recreational hours Q1 (0 <4,896) 52/ / Q2 (4,896 <7,942) 60/ , / , 4.9 Q3 (7,942 <11,874) 55/ , / , 4.7 Q4 (11,874 38,565) 45/ , / , 11.0 p for trend < p for trend < Adult recreational hours Q1 (0 <2,383) 53/ / Q2 (2,383 <4,987) 56/ , / , 4.3 Q3 (4,987 <8,437) 53/ , / , 4.1 Q4 (8,437 34,737) 50/ , / , 10.2 p for trend ¼ p for trend < Childhood recreational hours Q1 (0 <1,595) 58/ / Q2 (1,595 <2,864) 54/ , / , 4.5 Q3 (2,864 <3,828) 34/ , / , 5.6 Q4 (3,828 5,104) 74/ , / , 7.4 p for trend ¼ p for trend < Last-decade hours Q1 (0 <1) 61/ / Q2 (1 <1,693) 44/ , / Q3 (1,693 <3,463) 54/ , / , 7.3 Q4 (3,463 7,291) 55/ , / , 7.9 p for trend ¼ p for trend < Adult occupational hours Q1 (0 <1) 48/ / Q2 (1 <2,178) 41/ , / , 11.3 Q3 (2,178 <6,185) 46/ , / , 11.5 Q4 (6,185 32,862) 53/ , / , 21.9 p for trend ¼ p for trend < * OR, odds ratio; CI, confidence interval; Q, quartile. y Adjusted for age, sex, and skin type (refer to the text). was characterized by replacement of the papillary dermis by clumped elastotic fibers and/or amorphous masses of elastotic material. Of the 925 biopsies overall, 82 percent were evaluable for solar elastosis. Statistical analysis We began our analyses by examining the associations between presence of solar keratosis (yes/no) and degree of histologic solar elastosis. Because so few subjects had mild elastoses, we combined the moderate and mild categories and compared them with severe elastosis. We first examined demographic factors (e.g., age and sex), pigmentary characteristics, sun sensitivity, and clinical features of the tumor (e.g., histology and anatomic site). This step included logistic regression models to estimate the odds ratio and 95 percent confidence interval associated with each factor stratified or adjusted for age and sex. Skin color measured on the colorimeter is a continuous variable, so we used quartiles of the reflectance values in the study population. We calculated sun exposure variables based on the calendar (i.e., for days worked and not at work) and interview response data. For the present analysis, variables of interest included total lifetime hours spent outdoors from 9 a.m. to 5 p.m. and between 10 a.m. and 2 p.m. during working and nonworking hours, and during the summer (i.e., warmer months). Additionally, we computed an index of intermittent sun exposure as the proportion of time spent outdoors
6 724 Karagas et al. during nonworking hours. Sun exposure, sunbathing, and sunburn variables were evaluated according to age at exposure (<15 years, 15 years). We chose the cutpoint for age at exposure based on the literature indicating that the magnitude of association between sunlight exposure and risk of SCC and BCC decreases after ages 10ÿ19 years (14 16). We further computed total hours of sunbathing and number of painful and blistering sunburns. For each of these measures, we assessed exposures specifically to the anatomic site of the tumor and evaluated them as ordinal categorical (e.g., quartiles based on the distribution in the study group) variables, and we computed a p for trend for the ordinal variables (17). For variables with strongly skewed distributions, unitary categories were applied (e.g., for number of lifetime blistering sunburns: 0, 1, 2). We assessed the potential confounding effects of histologic type (BCC, SCC), age, sun sensitivity, and other factors by using stratified analyses and logistic regression. We specifically evaluated the interaction between sex and each of the sun exposure variables but did not find evidence of one. In addition, associations did not appear to differ by histology of the tumor itself (BCC vs. SCC) for solar elastosis (and was limited to a single histology, SCC for solar keratoses); therefore, in our final models, we combined both types of tumors. RESULTS Prevalence of solar keratoses did not vary by anatomic location (table 1). Severe solar elastosis was more common in SCC than in BCC tumors (85 percent and 71 percent with severe solar elastosis, 12 percent and 23 percent with moderate, and 6 percent and 3 percent with mild, respectively, and <1 percent with none present for both types). Furthermore, severe solar elastosis occurred far more frequently in biopsies from the head and neck than from other sites (odds ratio for both sexes ¼ 11.6, 95 percent confidence interval: 7.5, 18.6) and more so in men (odds ratio ¼ 20.1, 95 percent confidence interval: 10.8, 39.7) (table 1) than women (odds ratio ¼ 6.2, 95 percent confidence interval: 3.3, 12.0) (table 1). The interaction with sex was not statistically significant, however. The prevalence of solar keratoses increased with age among women but not men (p for trend ¼ and p for trend ¼ 0.802, respectively) (table 1). The prevalence of severe elastosis increased with age among both men and women, although the magnitude of the increase appeared stronger among women (table 1). Presence of solar elastosis was inversely related to a phenotype sensitive to first summer exposure to the sun (i.e., tended to burn) (p for trend ¼ 0.018) but appeared unrelated to skin sensitivity for prolonged sun exposure (table 2). In contrast, the prevalences of solar keratoses and severe solar elastosis were the highest among those with red hair color assessed by matching to wig samples, although with limited statistical precision, and did not vary significantly by eye color (table 2). There was no evidence of effect modification by sex in these comparisons (data not shown). Measures of acute or intense exposure generally were unrelated to the prevalence of solar keratoses and severe solar elastosis (table 3). A high frequency of sunbathing with the site exposed was associated with a lower prevalence of severe solar elastosis (odds ratio ¼ 0.4, 95 percent confidence interval: 0.2, 0.7) (table 3). Adjustment for total lifetime hours spent outdoors from 9 a.m. to 5 p.m. did not appreciably alter these results (data not shown). Measures of cumulative sun exposure at the site related to an increased risk of solar keratosis or severe solar elastosis (table 3). Amount of time spent outdoors during recreational activities (nonworking hours) during the warmer months, both in childhood and adulthood, was associated with both solar keratosis and severe solar elastosis, although the p for trend for childhood exposure was statistically significant for solar elastosis only. Time spent outdoors during the last decade and time spent outdoors during occupational (working) hours were highly related to histologic evidence of severe solar elastosis and, to a lesser extent, solar keratoses (table 3). We did not detect any major differences in the odds ratios between men and women with either acute or chronic measures of sun exposure for either solar keratosis or severe solar elastosis; none of the interaction terms were statistically significant (data not shown). Likewise, we did not detect appreciable differences when we stratified results for solar elastosis by tumor histology (i.e., SCC vs. BCC) (data not shown). Data for some variables indicated stronger associations when restricted to exposures between 10 a.m. and 2 p.m., but the results were generally consistent with the findings for exposures between 9 a.m. and 5 p.m. (data not shown). DISCUSSION In a large, population-based study of skin cancer, we compared responses to a standardized sun exposure questionnaire, frequently used in epidemiologic studies, with histologic evidence of solar damage assessed by a single dermatopathologist. After analyzing more than 100 variables, we found that those estimating cumulative number of hours spent outdoors related to histologic evidence of solar damage (solar keratoses and solar elastosis). We restricted our analysis to estimates specific to whether the affected anatomic site was exposed to sun, eliminating potential misclassification by times when the site was covered (unexposed). In contrast to measures of cumulative exposure, measures of acute, intense exposure (e.g., sunburns or sunbathing), or a tendency to sunburn, if anything were associated with a lower prevalence of actinic damage histologically. UVR from the sun is an established cause of BCC and SCC (18, 19), but many questions remain for which valid instruments of exposure assessment are needed. Epidemiologic studies have attempted to quantify a person s lifetime sun exposure history through time-consuming personal interviews. As in our study, interviews typically question subjects about time spent outdoors over their lifetime during the day, during midday, in warmer and cooler months, and during occupational and recreational activities in addition to history of sunburns (i.e., severe sunburns or blistering sunburns). Collection of sun exposure history using this
7 Measurement of Sun Exposure 725 instrument is designed to produce quantitative information with minimal recall bias. Nonetheless, studies of melanoma indicate the potential presence of recall bias for sun sensitivity and sunbathing, although the results are not conclusive (20, 21). Furthermore, it is conceivable that the best predictors (e.g., time spent outdoors) of solar keratoses or elastosis were simply better recalled than other factors (e.g., number of severe sunburns). In general, studies on the reproducibility of standard sun exposure and sunburn history questions suggest reasonable reliability of subject responses (4, 6). In a European study (4), 90 cases and 90 controls were reinterviewed about 1 year apart. For several key sunlight-related variables (e.g., hours/week of sun exposure), the intraclass correlation coefficients were 0.6ÿ0.7 between the two interviews and did not differ by case-control status. A similar study from Australia found an intraclass correlation for time spent outdoors of 0.77 (95 percent confidence interval: 0.71, 0.83) (6). While informative, neither study had a gold standard to which exposure estimates could be compared. Clinical signs of solar skin damage, assessed by dermatologic examination, are perhaps the strongest solar-related indicators of both BCC and SCC risk, in particular solar keratoses (14, 22). However, to date, no known studies have assessed these characteristics by using histopathologic criteria; biopsies of normal skin usually cannot be obtained in epidemiologic studies because they require a trained health care provider. In our study, we used histologic evidence of actinic damage in normal skin tissue adjacent to the skin cancer as a gold standard for chronic actinic damage. While feasible, an obvious limitation of this approach is that our results were based on the biopsies of tumors from skin cancer affected persons, rather than unaffected controls, and unaffected tissue. Thus, the prevalence of actinic damage likely exceeds what would be observed in the skin of normal controls (23) and indeed was higher in the skin adjacent to SCC than BCC tumors. However, we do not know how our findings would compare with studies that evaluated the normal skin of melanoma biopsies, for example, which appear to have far less evidence of solar damage histologically (24). Measurement of genetic alterations of UVR damage, that is, UVR-related TP53 mutations, may be useful biomarkers of sun exposure but have not yet been applied to large-scale epidemiologic investigations (25 28). Estimates of cumulative sun exposure, based on a complex series of questions, related very clearly to histologic evidence of actinic damage. Of interest, measures of cumulative exposure in childhood and in the decade prior to diagnosis were especially related to the presence of both measures. In a number of epidemiologic studies, sun exposure during childhood or the teenage years specifically related to risk of all types of skin cancer (1). In Alberta, Canada, occupational sun exposure in the 10 years prior to diagnosis was associated with an increased risk of SCC (29), suggesting an effect of recent exposure. Supporting this hypothesis are findings from a clinical trial in which recent use of sunscreens prevented SCC, but not BCC, occurrences (30). Thus, our data provide evidence that both early and recent exposures have a biologic basis in that they result in actinic damage to the skin that is discernable histologically. Our results, assuming that the findings are confirmed, suggest that questionnaire-derived measures of intense, intermittent exposure, that is, sunburns, are not linked with histologically recognizable actinic damage in skin tissue or may even be related to a diminished prevalence. Sunburns primarily affect the epidermis and therefore may not cause abnormal elastin response in the dermis; however, solar keratoses are of epidermal origin. Sunburns induce an inflammatory and apoptotic response, which in part might explain the absence of a positive association with histologic measures of chronic UVR response. Hence, a role for sunburns in the etiology of skin cancer must lie elsewhere. In conclusion, our findings based on histologic evidence of actinic damage suggest that measures of sun exposure derived from a personal interview accurately reflect a person s exposure history. Further studies incorporating molecular-genetic markers of UVR damage such as signature UVR TP53 mutations may provide additional insights into the validity of the questionnaire instruments. Ultimately, studies that investigate the full spectrum of sun exposure history variables along with molecular-genetic markers of UVR damage may help to discern the patterns of exposure that pose an excess risk and, in turn, more effectively guide preventive strategies for these common malignancies. ACKNOWLEDGMENTS This work was in part supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics and by grants R01CA57494 and R01CA from the National Institutes of Health. The authors are indebted to the physicians who constitute the New Hampshire Skin Cancer Study Group and to the New Hampshire Society of Dermatology. Conflict of interest: none declared. REFERENCES 1. Karagas M, Weinstock MA, Nelson HH. Keratinocyte cancers (basal cell and squamous cell carcinomas of the skin). New York, NY: Oxford University Press, Gallagher RP, Hill GB, Bajdik CD, et al. Sunlight exposure, pigmentation factors, and risk of nonmelanocytic skin cancer. II. Squamous cell carcinoma. Arch Dermatol 1995;131: Kricker A, Armstrong BK, English DR, et al. Does intermittent sun exposure cause basal cell carcinoma? A case-control study in Western Australia. Int J Cancer 1995;60: Rosso S, Zanetti R, Martinez C, et al. The multicentre south European study Helios. II: Different sun exposure patterns in the aetiology of basal cell and squamous cell carcinomas of the skin. Br J Cancer 1996;73: van Dam RM, Huang Z, Rimm EB, et al. Risk factors for basal cell carcinoma of the skin in men: results from the Health Professionals Follow-up Study. Am J Epidemiol 1999;150:
8 726 Karagas et al. 6. English DR, Armstrong BK, Kricker A, et al. Case-control study of sun exposure and squamous cell carcinoma of the skin. Int J Cancer 1998;77: Karagas MR, Greenberg ER, Spencer SK, et al. Increase in incidence rates of basal cell and squamous cell skin cancer in New Hampshire, USA. Int J Cancer 1999;81: Kricker A, Armstrong BK, English DR, et al. Pigmentary and cutaneous risk factors for non-melanocytic skin cancer a case-control study. Int J Cancer 1991;48: English DR, Armstrong BK, Kricker A. Reproducibility of reported measurements of sun exposure in a case-control study. Cancer Epidemiol Biomarkers Prev 1998;7: Elwood JM, Gallagher RP, Hill GB, et al. Pigmentation and skin reaction to sun as risk factors for cutaneous melanoma: Western Canada Melanoma Study. Br Med J (Clin Res Ed) 1984;288: Green A, Bain C, McLennan R, et al. Risk factors for cutaneous melanoma in Queensland. Recent Results Cancer Res 1986; 102: Holman CD, Armstrong BK, Evans PR, et al. Relationship of solar keratosis and history of skin cancer to objective measures of actinic skin damage. Br J Dermatol 1984;110: Urbach F, Rose D, Bonnem M. Genetic and environmental interactions in skin carcinogenesis. In: Environment and cancer: a collection of papers presented at the 24th Annual Symposium on Fundamental Cancer Research. Baltimore, MD: Williams & Wilkins, 1972: English D, Armstrong BK, Kricker A, et al. Demographic characteristics, pigmentary and cutaneous risk factors for squamous cell carcinoma of the skin: a case-control study. Int J Cancer 1998;76: Grodstein F, Speizer FE, Hunter DJ. A prospective study of incident squamous cell carcinoma of the skin in the Nurses Health Study. J Natl Cancer Inst 1995;87: Kricker A, Armstrong BK, English DR, et al. Pigmentary and cutaneous risk factors for non-melanocytic skin cancer a case-control study. Int J Cancer 1991;48: Breslow NE, Day NE, eds. Statistical methods in cancer research. Vol 1. The analysis of case-control studies. Lyon, France: International Agency for Research on Cancer, (IARC scientific publication no. 32). 18. Solar and ultraviolet radiation. IARC monographs on the evaluation of carcinogenic risks to humans. Vol 55. Lyon, France: International Agency for Research on Cancer, 1992;55: Kricker A, Armstrong BK, English DR. Sun exposure and non-melanocytic skin cancer. Cancer Causes Control 1994; 5: Cockburn M, Hamilton A, Mack T. Recall bias in selfreported melanoma risk factors. Am J Epidemiol 2001;153: Weinstock MA, Colditz GA, Willett WC, et al. Recall (report) bias and reliability in the retrospective assessment of melanoma risk. Am J Epidemiol 1991;133: Green A, Battistutta D. Incidence and determinants of skin cancer in a high-risk Australian population. Int J Cancer 1990;46: Moon JS, Oh CH. Solar damage in skin tumors: quantification of elastotic material. Dermatology 2001;202: Berwick M, Armstrong BK, Ben-Porat L, et al. Sun exposure and mortality from melanoma. J Natl Cancer Inst 2005;97: Einspahr J, Alberts DS, Aickin M, et al. Expression of p53 protein in actinic keratosis, adjacent, normal-appearing, and non-sun-exposed human skin. Cancer Epidemiol Biomarkers Prev 1997;6: Nakazawa H, English D, Randell PL, et al. UV and skin cancer: specific p53 gene mutation in normal skin as a biologically relevant exposure measurement. Proc Natl Acad Sci U S A 1994;91: Ouhtit A, Nakazawa H, Armstrong BK, et al. UV-radiationspecific p53 mutation frequency in normal skin as a predictor of risk of basal cell carcinoma. J Natl Cancer Inst 1998;90: Ouhtit A, Ueda M, Nakazawa H, et al. Quantitative detection of ultraviolet-specific p53 mutations in normal skin from Japanese patients. Cancer Epidemiol Biomarkers Prev 1997; 6: Gallagher RP, Hill GB, Bajdik CD, et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer I. Basal cell carcinoma. Arch Dermatol 1995;131: Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet 1999;354:723 9.
Sunlight Exposure, Pigmentation Factors and Risk of Nonmelanocytic Skin Cancer II. Squamous Cell Carcinoma
Sunlight Exposure, Pigmentation Factors and Risk of Nonmelanocytic Skin Cancer II. Squamous Cell Carcinoma Richard P. Gallagher, MA; Gerry B. Hill, MB, ChB, MSc, FRCPC; Chris D. Bajdik, Msc; Andrew J.
More informationPhotosensitizing Agents and the Risk of Non-Melanoma Skin Cancer: A Population-Based Case Control Study
ORIGINAL ARTICLE See related commentary on pg 1922 Photosensitizing Agents and the Risk of Non-Melanoma Skin Cancer: A Population-Based Case Control Study Sarah N. Robinson 1, Michael S. Zens 1, Ann E.
More informationP R O T E C T I O N O F A U T H O R S C O P Y R I G H T
THE UNIVERSITY LIBRARY P R O T E C T I O N O F A U T H O R S C O P Y R I G H T This copy has been supplied by the Library of the University of Otago on the understanding that the following conditions will
More informationTable 2.1. Case-control studies of sun exposure and basal cell carcinoma, published after 1992
Reference, study location & period Gallagher et al (995a), Alberta, Canada, 983 984 Cases Controls Exposure assessment 226 M with incident BCC from cancer registry, 25 79 yrs, stratified by site; response
More informationThe aetiological significance of sunlight and fluorescent lighting in malignant melanoma: A case-control study
Br. J. Cancer (1985), 52, 765-769 The aetiological significance of sunlight and fluorescent lighting in malignant melanoma: A case-control study T. Sorahan' & R.P. Grimley2 1Cancer Epidemiology Research
More informationRunning head: SUNBURN AND SUN EXPOSURE 1. Summer Sunburn and Sun Exposure Among US Youths Ages 11 to 18: National Prevalence and Associated Factors
Running head: SUNBURN AND SUN EXPOSURE 1 Summer Sunburn and Sun Exposure Among US Youths Ages 11 to 18: National Prevalence and Associated Factors Ashley Roberts University of Cincinnati SUNBURN AND SUN
More informationKeppel Street, London WC1E 7HT. In addition, a large proportion of melanomas. been suggested that prolonged exposure to
Br. J. Cancer (1981) 44, 886 THE RELATIONSHIP OF MALIGNANT MELANOMA, BASAL AND SQUAMOUS SKIN CANCERS TO INDOOR AND OUTDOOR WORK V. BERAL AND N. ROBINSON From the Epidemiological Monitoring Unit, London
More informationBJD. Summary. British Journal of Dermatology EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH
EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH BJD British Journal of Dermatology Recent skin self-examination and doctor visits in relation to melanoma risk and tumour depth L.J. Titus, 1,2 K. Clough-Gorr,
More informationISPUB.COM. Counseling to Prevent Skin Cancer: Recommendations And Rationale: United States Preventive Services Task Force
ISPUB.COM The Internet Journal of Oncology Volume 2 Number 1 Counseling to Prevent Skin Cancer: Recommendations And Rationale: United States Preventive Services Task Force United States Preventive Services
More informationSun Safety and Skin Cancer Prevention. Maryland Skin Cancer Prevention Program
Sun Safety and Skin Cancer Prevention Maryland Skin Cancer Prevention Program Do You Know the Facts About Skin Cancer? Skin cancer is the most common cancer but also the most preventable Childhood sunburn
More informationTable Case control studies of combined estrogen progestogen contraceptives and malignant melanoma
Table 2.10. Case control studies of combined estrogen progestogen contraceptives and malignant melanoma of Beral et al. (1977), Adam et al. (1981), United Kingdom Holly et al. (1983), Seattle, Lew et al.
More informationThe naevus count on the arms as a predictor of the number of melanocytic naevi on the whole body
British Journal of Dermatology 1999; 140: 457 462. The naevus count on the arms as a predictor of the number of melanocytic naevi on the whole body C.FARIÑAS-ÁLVAREZ, J.M.RÓDENAS,* M.T.HERRANZ AND M.DELGADO-RODRÍGUEZ
More informationSun exposure and indoor tanning and skin cancer
Reviews and Meta-analyses analyses of Sun exposure and indoor tanning and skin cancer Sara Gandini, PhD Division of Epidemiology and Biostatistics European Institute of Oncology - Milan, Italy Phenotypical
More informationSunscreens and cutaneous neoplasia:
Sunscreens and cutaneous neoplasia: Overview and update from the literature Catherine Olsen, Louise Wilson, Neela Biswas, Juhi Loyalka, David Whiteman Cancer Control Group QIMR Berghofer Medical Research
More informationSkin Cancer. Dr Elizabeth Ogden Associate Specialist in Dermatology East and North Herts Dr Elizabeth Ogden
Skin Cancer Dr Elizabeth Ogden Associate Specialist in Dermatology East and North Herts 13.10.16 Skin Cancer Melanoma mole cancer - is a true cancer which can metastasize and kill Non Melanoma skin cancer
More informationClinical characteristics
Skin Cancer Fernando Vega, MD Seattle Healing Arts Clinical characteristics Precancerous lesions Common skin cancers ACTINIC KERATOSIS Precancerous skin lesions Actinic keratoses Dysplastic melanocytic
More informationFACTORS ASSOCIATED WITH NEVUS VOLATILITY IN EARLY ADOLESCENCE
FACTORS ASSOCIATED WITH NEVUS VOLATILITY IN EARLY ADOLESCENCE The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Oliveria,
More informationActinic keratosis (AK): Dr Sarma s simple guide
Actinic keratosis (AK): Dr Sarma s simple guide Actinic keratosis is a very common lesion that you will see in your day-to-day practice. First, let me explain the name Actinic keratosis. It means keratosis
More informationTHE EPIDEMIOLOGY Of ACQUIRED MELANOCYTIC NEVI A Brief Review
THE EPIDEMIOLOGY Of ACQUIRED MELANOCYTIC NEVI A Brief Review Richard P. Gallagher, MA, and David I. McLean, MD, FRCPC Malignant melanoma incidence has risen markedly over the past 30 to 40 years and continues
More informationSTUDY. Analysis of the Melanoma Epidemic, Both Apparent and Real
Analysis of the Melanoma Epidemic, Both Apparent and Real Data From the 1973 Through 1994 Surveillance, Epidemiology, and End Results Program Registry Leslie K. Dennis, PhD STUDY Background: The incidence
More informationTalking to Your Clients About Skin Cancer. Objectives 9/9/2017. Amanda Friedrichs, MD, FAAD AMTA National Conference September 14, 2017
Talking to Your Clients About Skin Cancer Amanda Friedrichs, MD, FAAD AMTA National Conference September 14, 2017 Objectives Provide general information about skin cancer and how skin cancers commonly
More informationDisease worksheets. Disability weights (Dutch weights) Table A3.1. Section 1: Worksheet for: Cutaneous malignant melanoma (CMM)
Annex 3 Disease worksheets Section 1: Worksheet for: Cutaneous malignant melanoma (CMM) Case definition and sequelae: (ICD-1) C43. The disability weights used in this study are listed in Table A3.1. Table
More informationSunburn, suntan and the risk of cutaneous malignant melanoma The Western Canada Melanoma Study J.M. Elwood1, R.P. Gallagher2, J.
Br. J. Cancer (1985), 51, 543-549 Sunburn, suntan and the risk of cutaneous malignant melanoma The Western Canada Melanoma Study J.M. Elwood1, R.P. Gallagher2, J. Davison' & G.B. Hill3 1Department of Community
More informationIT S FUNDAMENTAL MY DEAR WATSON! A SHERLOCKIAN APPROACH TO DERMATOLOGY
IT S FUNDAMENTAL MY DEAR WATSON! A SHERLOCKIAN APPROACH TO DERMATOLOGY Skin, Bones, and other Private Parts Symposium Dermatology Lectures by Debra Shelby, PhD, DNP, FNP-BC, FADNP, FAANP Debra Shelby,
More informationSteven Robinson. Steven Robinson Memorial Endowment at
fchwmt.org Steven Robinson Steven Robinson Memorial Endowment at Fair hair and skin Steven s story Grew up around water and loved being outdoors Experienced several sunburns as a child and young adult
More informationDermatopathology: The tumor is composed of keratinocytes which show atypia, increase mitoses and abnormal mitoses.
Squamous cell carcinoma (SCC): A common malignant tumor of keratinocytes arising in the epidermis, usually from a precancerous condition: 1- UV induced actinic keratosis, usually of low grade malignancy.
More informationRegression 2/3/18. Histologically regression is characterized: melanosis fibrosis combination of both. Distribution: partial or focal!
Regression Margaret Oliviero MSN, ARNP Harold S. Rabinovitz MD Histologically regression is characterized: melanosis fibrosis combination of both Distribution: partial or focal! Dermatoscopic terminology
More informationHigh Levels of Ultraviolet B Exposure Increase the Risk of Non-Melanoma Skin Cancer in Psoralen and Ultraviolet A-Treated Patients
High Levels of Ultraviolet B Exposure Increase the Risk of Non-Melanoma Skin Cancer in Psoralen and Ultraviolet A-Treated Patients Jean Lee Lim and Robert S. Stern w Harvard Medical School, Boston, Massachusetts,
More informationFlexible Matching in Case-Control Studies of Gene-Environment Interactions
American Journal of Epidemiology Copyright 2004 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 59, No. Printed in U.S.A. DOI: 0.093/aje/kwg250 ORIGINAL CONTRIBUTIONS Flexible
More informationResearch Article Sunscreen Use on the Dorsal Hands at the Beach
Skin Cancer Volume 2013, Article ID 269583, 6 pages http://dx.doi.org/10.1155/2013/269583 Research Article Sunscreen Use on the Dorsal Hands at the Beach Donald B. Warren, 1 Ryan R. Riahi, 2 Jason B. Hobbs,
More informationMelanoma incidence on the rise again 450 2
Perspective Melanoma incidence on the rise again 450 2 Following a period of falling rates, the incidence of cutaneous malignant melanoma has increased steadily for the past ten years in Norway. It is
More informationEarly-life or lifetime sun exposure, sun reaction, and the risk of squamous cell carcinoma in an Asian population
Cancer Causes Control (2010) 21:771 776 DOI 10.1007/s10552-010-9505-x ORIGINAL PAPER Early-life or lifetime sun exposure, sun reaction, and the risk of squamous cell carcinoma in an Asian population Yen-Ching
More informationChildhood Cancer Survivor Study Analysis Concept Proposal
Title: Multiple Subsequent Neoplasms Working Group and Investigators: Childhood Cancer Survivor Study Analysis Concept Proposal This proposed publication will be within the Second Malignancy Working Group
More informationSkin Cancer 101: Diagnosis and Management of the Most Common Cancer
Skin Cancer 101: Diagnosis and Management of the Most Common Cancer Sarah Patton, PA-C, MSHS Skin Surgery Center www.skinsurgerycenter.com Seattle/Bellevue, WA Skin cancer Skin cancer is by far the most
More informationSunscreen Use Before and After Transplantation and Assessment of Risk Factors Associated With Skin Cancer Development in Renal Transplant Recipients
STUDY Sunscreen Use Before and After Transplantation and Assessment of Risk Factors Associated With Skin Cancer Development in Renal Transplant Recipients Fergal J. Moloney, MD; Esmaeel Almarzouqi, MD;
More informationMelanoma: A new strategy to reduce morbidity and. mortality
Australasian Medical Journal [AMJ 2014, 7, 7, 266 271] Melanoma: A new strategy to reduce morbidity and mortality Cameron Williams, Christopher Quirk, Anna Quirk Austin Hospital, Melbourne, Australia RESEARCH
More informationCould sun exposure improve melanoma survival?
95 In: Solar Radiation and Human Health Espen Bjertness, editor. Oslo: The Norwegian Academy of Science and Letters, 2008. Could sun exposure improve melanoma survival? Marianne Berwick University of New
More informationGlenn D. Goldman, MD. Fletcher Allen Health Care. University of Vermont College of Medicine
Glenn D. Goldman, MD Fletcher Allen Health Care University of Vermont College of Medicine Recognize and identify the main types of skin cancer Understand how and why Mohs surgery is utilized for the treatment
More informationWork Place Carcinogens Solar Radiation and Skin Cancer. November 2013 Dr Mark Foley
Work Place Carcinogens Solar Radiation and Skin Cancer November 2013 Dr Mark Foley Overview Work place carcinogens and skin cancer Who is a risk? Screening and Self skin exam Common skin cancers Many work
More informationAndrew Lee Kieran Benjamin Garbutcheon-Singh Shreya Dixit Pam Brown Saxon D. Smith
Am J Clin Dermatol DOI 10.1007/s40257-014-0106-4 ORIGINAL RESEARCH ARTICLE The Influence of Age and Gender in Knowledge, Behaviors and Attitudes Towards Sun Protection: A Cross-Sectional Survey of Australian
More informationCancer Association of South Africa (CANSA)
Cancer Association of South Africa (CANSA) Fact Sheet on the Use of Sunbeds Introduction A sunbed, also known as a tanning bed or sun tanning bed, is a device that emits ultraviolet radiation (typically
More informationHealthy Skin Education in Alabama s Schools. Alabama Comprehensive Cancer Control Program
Healthy Skin Education in Alabama s Schools Alabama Comprehensive Cancer Control Program Skin cancer is the most common form of cancer in the US. Skin cancer is the uncontrolled growth of abnormal skin
More informationHave a Voice in Your Choice!
Have a Voice in Your Choice! BLU-U Blue Light Photodynamic Therapy The LEVULAN KERASTICK for Topical Solution plus blue light illumination using the BLU-U Blue Light Photodynamic Therapy Illuminator is
More informationDermatology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI Memorial
Dermatology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI Memorial Cutaneous Oncology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI
More informationSUBUNGUAL MALIGNANT MELANOMA ON THE RIGHT INDEX IN A DENTIST AFTER PROLONGED OCCUPATIONAL EXPOSURE TO X-RAYS
SUBUNGUAL MALIGNANT MELANOMA ON THE RIGHT INDEX IN A DENTIST AFTER PROLONGED OCCUPATIONAL EXPOSURE TO X-RAYS J. HATZIS*, V. MAKROPOULOS**, N. AGNANTIS*** * Department of Skin and Venereal Diseases, University
More informationExposure to sunlamps, tanning beds, and melanoma risk
Cancer Causes Control (2008) 19:659 669 DOI 10.1007/s10552-008-9129-6 ORIGINAL PAPER Exposure to sunlamps, tanning beds, and melanoma risk Kerri M. Clough-Gorr Æ Linda Titus-Ernstoff Æ Ann E. Perry Æ Steven
More informationEvaluation of Skin Microtopography as a Measure of Ultraviolet Exposure
Investigative Ophthalmology & Visual Science, Vol. 33, No., May 99 Copyright Association for Research in Vision and Ophthalmology Evaluation of Skin Microtopography as a Measure of Ultraviolet Exposure
More informationPsychological factors associated with skin cancer detection behaviors in individuals with a family history of melanoma
University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School 2003 Psychological factors associated with skin cancer detection behaviors in individuals with a family history
More informationUV and Children s Skin
UV and Children s Skin Beate Volkmer and Rüdiger Greinert Division of Molecular Cellbiology Center of Dermatology, Elbeklinikum Buxtehude Germany Epidemiological studies indicate that sunburns in childhood
More informationPeriocular Malignancies
Periocular Malignancies Andrew Gurwood, O.D., F.A.A.O., Dipl. Marc Myers, O.D., F.A.A.O. Drs. Myers and Gurwood have no financial interests to disclose. Course Description Discussion of the most common
More informationHOME WORKERS AND ULTRAVIOLET RADIATION EXPOSURE
HOME WORKERS AND ULTRAVIOLET RADIATION EXPOSURE M.G.Kimlin 1,2+, A.V. Parisi 1 and J.C.F. Wong 2 1 Centre for Astronomy and Atmospheric Research, University of Southern Queensland, Toowoomba, 4350, Australia
More informationEnvironmental Health and Safety. Sun Safety. Greg Hogan Oklahoma State University Environmental Health and Safety (405)
Sun Safety Greg Hogan Oklahoma State University Environmental Health and Safety (405) 744-7241 Current as of June 2018 Objective The Skin Cancer Problem The Sun and Your Skin Assessing Your Personal Risk
More informationCutaneous malignant melanoma (CMM) is a major
The Queensland Study of Melanoma: Environmental and Genetic Associations (Q-MEGA); Study Design, Baseline Characteristics, and Repeatability of Phenotype and Sun Exposure Measures Amanda J. Baxter, 1 Maria
More informationDoes Photoprotection Lower the Risk for Skin Cancer?
Does Photoprotection Lower the Risk for Skin Cancer? Henry W. Lim, MD Chair Emeritus, Department of Dermatology Senior Vice President for Academic Affairs Henry Ford Hospital, Detroit, Michigan Disclosure
More informationBenign and malignant epithelial lesions: Seborrheic keratosis: A common benign pigmented epidermal tumor occur in middle-aged or older persons more
Benign and malignant epithelial lesions: Seborrheic keratosis: A common benign pigmented epidermal tumor occur in middle-aged or older persons more common on the trunk; but extremities, head and neck are
More informationSun exposure in outdoor workers: Friend or foe?
Sun exposure in outdoor workers: Friend or foe? Cheryl Peters, PhD Occupational & Environmental Seminar Friday, October 2 nd, 2015 1. Postdoctoral Fellow, Carleton University & Institut National de la
More informationA dinical and histopathologic entity associated with an increased risk of nonmelanoma skin cancer
PUVA keratosis A dinical and histopathologic entity associated with an increased risk of nonmelanoma skin cancer M. C. G. van Praag, MD, a J. N. Bouwes Bavinck, MD, a W. Bergman, MD, PhD, a F. R. Rosendaal,
More informationDRAFT. Table 2.9. Case-control studies of exposure to natural sunlight and cancers of the eye. Cases Controls Exposure assessment
Squamous cell carcinoma of the conjunctiva Napora et al. (199), USA, 1981 1987 19 patients with conjunctival intraepithelial neoplasia selected from the Cornea Service, Wills Eye Hospital; aged 52 82 years;
More informationIdentifying Skin Cancer. Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018
Identifying Skin Cancer Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018 American Cancer Society web site Skin Cancer Melanoma Non-Melanoma
More informationIdentifying Risk Factors Using a Skin Cancer Screening Program
Age, personal history, and exposure to sun are risk factors for a presumptive diagnosis of skin cancer. Tenzin Norbu Lama. Crossing the Pass (detail). Identifying Risk Factors Using a Skin Cancer Screening
More informationChanges in the pattern of sun-exposure and sunprotection in young children from tropical Australia
Changes in the pattern of sun-exposure and sunprotection in young children from tropical Australia A. Smith, 1 S.Harrison, 1 M. Nowak, 1 P. Buettner, 1 R. MacLennan 1,2 1. Skin Cancer Research Group, School
More informationAre Patients with Skin Cancer at Lower Risk of Developing Colorectal or Breast Cancer?
American Journal of Epidemiology ª The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.
More informationThe future of Skin Cancer Treatment
The future of Skin Cancer Treatment What is ZaicaDerm? Fully formulated cream that delivers Tea Tree Oil in a transdermal format Using proprietary technology, ZaicaDerm, delivers 10% Tea Tree Oil below
More informationUNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA FACULTY OF MEDICINE DOCTORAL THESIS SUMMARY
UNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA FACULTY OF MEDICINE DOCTORAL THESIS SUMMARY CLINICAL, HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF THE EPITHELIAL PRECANCEROUS LESIONS PRECURSORS OF
More informationBeing safe in the sun can still be fun
A Sun Protection Primary Care Practice Manual Developed by: The Dept. of Community & Family Medicine Dartmouth-Hitchcock Medical Center and The Norris Cotton Cancer Center Hanover, NH Being safe in the
More informationPharmacovigilance Working Party (PhVWP)
24 March 2011 EMA/CHMP/PhVWP/217595/2011 Patient Health Protection Monthly report Issue number: 1103 Pharmacovigilance Working Party (PhVWP) March 2011 plenary meeting The CHMP Pharmacovigilance Working
More informationMELANOMA. 4 Fitzroy Square, London W1T 5HQ Tel: Fax: Registered Charity No.
MELANOMA This leaflet had been written to help you understand more about melanoma. It tells you what it is, what causes it, what can be done about it, how it can be prevented, and where you can find out
More information11 Melanoma of the skin
11 Melanoma of the skin 11.1 Summary Melanoma of the skin is the ninth most common cancer in Ireland, accounting for 2.4 of all malignant neoplasia in men and 4.2 in women, if non-melanoma skin cancers
More informationDoes Sunscreen Use Decrease the Incidence of Primary. Cutaneous Melanoma in Caucasians: A Systematic Review
Does Sunscreen Use Decrease the Incidence of Primary Cutaneous Melanoma in Caucasians: A Systematic Review By Rachel Blasiak A Master s Paper submitted to the faculty of the University of North Carolina
More informationPrevention. Skin cancer is the most common cancer in the. The Science of. by Laura Brockway-Lunardi, Ph.D.
66 DERMASCOPE June 2012 The Science of Prevention by Laura Brockway-Lunardi, Ph.D. Skin cancer is the most common cancer in the U.S. with more than two million Americans diagnosed annually. Basal cell
More informationGlenn D. Goldman, MD. University of Vermont Medical Center. University of Vermont College of Medicine
Glenn D. Goldman, MD University of Vermont Medical Center University of Vermont College of Medicine Recognize and identify the main types of skin cancer and their precursors Identify and understand new
More informationCarcinogenesis Advance Access published July 29, Citrus Consumption and Risk of Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin
Carcinogenesis Advance Access published July 29, 2015 Citrus Consumption and Risk of Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin Shaowei Wu 1,2, Eunyoung Cho 2,3,4, Diane Feskanich 3,
More informationBe SunSmart Everywhere!
Be SunSmart Everywhere! DID YOU KNOW? Sun exposure adds up day after day, and it happens every time you re in the sun. Damage is permanent and irreversible. MYTH Sunburn happens only when we go to the
More informationOverview 2/11/18. Skin cancer surveillance after cancer therapy: When to worry. Skin cancer risk factors and types. Time to onset
Skin cancer surveillance after cancer therapy: When to worry Carrie C. Coughlin, MD Assistant Professor, Dermatology Washington University School of Medicine F072 - The Big C's: Children, Cancer, and Cutaneous
More informationHistopathology: skin pathology
Histopathology: skin pathology These presentations are to help you identify, and to test yourself on identifying, basic histopathological features. They do not contain the additional factual information
More informationScottish Medicines Consortium
Scottish Medicines Consortium imiquimod 5% cream (Aldara) No. (385/07) Meda Pharmaceuticals Ltd 04 April 2008 The Scottish Medicines Consortium has completed its assessment of the above product and advises
More informationMelanoma: The Basics. What is a melanocyte?
Melanoma: The Basics What is a melanocyte? A melanocyte is a normal cell, found in the skin, which produces melanin. Melanin is a black or dark brown pigment that is seen in the skin, hair, and parts of
More informationCapstone Project Proposal
I. Mission Statement Capstone Project Proposal Sarah Storm Gross Increase adolescent awareness and knowledge regarding skin cancer and sun exposure in rural junior high classrooms across the state of Iowa
More informationMalignant Melanoma Early Stage. A guide for patients
This melanoma patient brochure is designed to help educate melanoma patients and their caregivers. It was developed under the guidance of Dr. Michael Smylie, Professor, Department of Oncology, University
More informationRole of Dietary Factors in the Development of Basal Cell Cancer and Squamous Cell Cancer of the Skin
1596 Cancer Epidemiology, Biomarkers & Prevention Role of Dietary Factors in the Development of Basal Cell Cancer and Squamous Cell Cancer of the Skin Sarah A. McNaughton, 1 Geoffrey C. Marks, 1 and Adele
More informationBASAL CELL CARCINOMA. Risk Factors for Single and Multiple Basal Cell Carcinomas STUDY
STUDY Risk Factors for Single and Multiple Basal Cell Carcinomas Ville Kiiski, MD; Esther de Vries, PhD; Sophie C. Flohil, MD; Monique J. Bijl, PhD; Albert Hofman, MD, PhD; Bruno H. C. Stricker, MD, PhD;
More informationEXCESSIVE SUN EXPOSURE A DANGER FACTOR FOR THE SKIN
EXCESSIVE SUN EXPOSURE A DANGER FACTOR FOR THE SKIN When the weather warms up, we all like to get more sunshine. While better weather can make us feel brighter, we must also be aware of the dangers as
More informationSun exposure and melanoma risk at different latitudes: a pooled analysis of 5700 cases and 7216 controls
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial
More informationSkin Cancer. There are many types of diseases. From a simple cold to the deadly disease
Skin Cancer Skin Cancer 1 There are many types of diseases. From a simple cold to the deadly disease Mesothelioma. Some diseases are almost harmless and some can kill you in less than a year. There are
More informationSkin Cancer - Non-Melanoma
Skin Cancer - Non-Melanoma Introduction Each year, millions of people find out that they have skin cancer. Skin cancer is almost 100% curable if found early and treated right away. It is possible to prevent
More informationDermoscopy: Recognizing Top Five Common In- Office Diagnoses
Dermoscopy: Recognizing Top Five Common In- Office Diagnoses Vu A. Ngo, DO Department of Family Medicine and Dermatology Choctaw Nation Health Services Authority Learning Objectives Introduction to dermoscopy
More informationSTUDY. Application Patterns Among Participants Randomized to Daily Sunscreen Use in a Skin Cancer Prevention Trial. are the most commonly occurring
STUDY Application Patterns Among Participants Randomized to Daily Sunscreen Use in a Skin Cancer Prevention Trial Rachel Neale, PhD; Gail Williams, PhD; Adèle Green, MB BS, PhD Background: Despite many
More informationPattern of skin malignancies in Manipur, India: A 5-year histopathological review
Original Article Pattern of skin malignancies in Manipur, India: A 5-year histopathological review Rajesh Singh Laishram, Alpana Banerjee, Pukhrambam Punyabati, L. Durlav Chandra Sharma Department of Pathology,
More informationSkin Cancer Awareness
Skin Cancer Awareness Presented by BHS Call: 800-327-2251 Visit: www.bhsonline.com 2016 BHS. All rights reserved. 1 Training Summary More than 3.5 million new cases of skin cancer will be diagnosed in
More informationMECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB. Friday, February 13, :30 am 11:00 am
MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB Friday, February 13, 2009 9:30 am 11:00 am FACULTY COPY GOALS: Describe the basic clinical and morphologic features of various
More informationAssociated Detection Patterns, Lesion Characteristics, and Patient Characteristics
1562 Thin Primary Cutaneous Melanomas Associated Detection Patterns, Lesion Characteristics, and Patient Characteristics Jennifer L. Schwartz, M.D. 1 Timothy S. Wang, M.D. 1 Ted A. Hamilton, M.S. 1 Lori
More informationMECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB. Friday, February 12, :30 am 11:00 am
MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB Friday, February 12, 2012 9:30 am 11:00 am FACULTY COPY GOALS: Describe the basic clinical and morphologic features of various
More informationKnow who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated
Lindy P. Fox, MD Assistant Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco Applies to adults without history of malignancy or premalignant
More informationBritsh Journal of Cancer (1996) 73, Stockton Press All rights reserved /96 $
Britsh Journal of Cancer (1996) 73, 1447-1454 1996 Stockton Press All rights reserved 0007-0920/96 $12.0000 The multicentre south European study 'Helios' II: different sun exposure patterns in the aetiology
More informationCombining genetic and exposure data significantly improves risk prediction for skin cancer
Combining genetic and exposure data significantly improves risk prediction for skin cancer Pierre Fontanillas, Babak Alipanahi, Michaela Johnson, Catherine Wilson, 23andMe Research Team, Steve Pitts, Robert
More informationSkin Cancer. The Facts
Skin Cancer Rates of skin cancer are increasing faster than any other cancer in the UK, with figures doubling every 10 to 20 years. More than 11,500 cases of malignant melanoma the deadliest form of skin
More informationSkin Cancer. 5 Warning Signs. American Osteopathic College of Occupational and Preventive Medicine OMED 2012, San Diego, Monday, October 8, 2012 C-1
Skin Cancer AMERICAN OSTEOPATHIC COLLEGE OF OCCUPATIONAL & PREVENTIVE MEDICINE OMED 2012 October 8, 2012 E. Robert Wanat II, D.O., M.P.H. Learning Objectives: Identify the 3 Basic Types of Skin Cancer
More informationDermatological Manifestations in the Elderly. Sanjay Siddha Staff Dermatologist UHN & MSH
Dermatological Manifestations in the Elderly Sanjay Siddha Staff Dermatologist UHN & MSH Disclosure No actual or potential conflicts of interest or commercial relationships to declare Objectives Recognize
More informationLearning Objectives. Tanning. The Skin. Classic Features. Sun Reactive Skin Type Classification. Skin Cancers: Preventing, Screening and Treating
Learning Objectives Skin Cancers: Preventing, Screening and Treating Robert A. Baldor, MD, FAAFP Professor, Family Medicine & Community Health University of Massachusetts Medical School Distinguish the
More information