Background: Skin cancer is one of the most preventable forms of cancer yet for certain types of skin cancers, it can be fatal if it goes untreated. While ultraviolet radiation is the main cause of skin cancer, there are several other risk factors, including sunburn history, smoking, environmental pollutants, family history, personal history, and skin color. Practicing sun protection behaviors and receiving regular skin cancer screenings can prevent the cancer from ever developing. This study examines the demographic and socioeconomic status risk factors for skin cancer. Methods: The Health Information National Trends Survey data was used from 2005. Using this secondary dataset, chi-square analysis was performed to determine the prevalence of skin cancer within the demographic categories of age and race/ethnicity as well as socioeconomic status indicators educational attainment, annual household income, employment status, and marital status. Univariate and multivariate analyses were performed to determine the correlations of the variables with skin cancer. A p-value of 0.05 and a 95% confidence interval were maintained throughout the analyses to determine any statistical significance. Results: Of the 3,804 respondents who answered the question related to cancer diagnosis, 226 indicated they had a positive skin cancer diagnosis, which was 5.94% of the total sample. Skin cancer and increased age were consistently associated (χ2 (2) = 171.5, p<.001). The skin cancer peak prevalence was for all those respondents aged 65 and older. Higher educational attainment and higher annual household income were associated with greater likelihood of skin cancer. Conclusions: This study revealed that skin cancer is significantly associated with increased age, higher educational attainment, and higher annual household income. Implementing consistent screening practices and targeted behavioral interventions are important areas for health focus in the future.

Infiltrative morphological mimicry at sites of biopsy-proven nodular basal cell carcinoma has been described. The immunoprofile of scar BCCs (scar BCCs,SBCCs) has not been documented. The aim of this study was to assess the histopathological spectrum, stromal (fibronectin, laminin, actin, desmin and vimentin) response and proliferation (bcl-2, MIB1 and p53) status of SBCCs. Twenty nine BCCs occurring in scars, unrelated to previous malignancy (de novo scar BCCS, DN-SBCCs), 27 BCCs that were incompletely excised and regrew at the same site (regrowth scar BCCs, RG-SBCCs) and 25 BCCs that were completely excised with tumour free margins, but recurred at the same site (recurrent scar BCCs, R-SBCCs) were accessed from the files of the Department of Pathology and Plastic and Reconstructive Surgery of the Faculty of Medicine, University of KwaZulu Natal, and formed the basis of this study. The morphological features of DN-SBCCs was pure (3%), predominantly nodular (79%), micronodular (7%) and infiltrative (11 %). RG-SBCCs were predominantly nodular (82%), micronodular (7%) and infiltrative (11%). RSBCCs were predominantly nodular (80%), micronodular (4%) and infiltrative (16%). The majority of DN-SBCCs, RG-SBCCs and R-SBCCs showed intact basement membrane laminin staining, while two (7%) DN-SBCCs showed 1 + and 2+ loss of basement membrane laminin staining. Three (11 %) and two (8%) RG-SBCCs and R-SBCCs,respectively, showed 2+ or 3+ basement membrane laminin discontinuity. The majority of DN-SBCCs (83%), RGSBCCs (75%) and R-SBCCs (88%) were actin negative. No desmin immunopositivity was demonstrated in the epithelial or stromal components of DN-SBCCs, RG-SBCCs and R-SBCCs. All BCC groups showed high 3+ or 4+ vimentin immunopositivity. The majority (>50%) of the SBCCs showed low (2+) bcl-2 immunopositivity. There was no significant difference in p53 immunopositivity in all SBCCs. SBCCs demonstrate phenotypic and immunophenotypic heterogeneity. That DN-SBCCs with the infiltrative and micronodular patterns have not recurred implies that the histomorphology is a pseudo-aggressive pattern. A similar view could pertain to RG-SBCCs, but because the scar did not cicatrise the incompletely excised BCC implies that the histomorphology of RG-BCC may be a potentially more aggressive phenotype. The recurrence of a completely excised basal cell carcinoma may be viewed as a feature of an aggressive tumour, especially when the recurrent BCC contains micronodular and infiltrative components. However, as most R-SBCCs occurred at head and neck sites that are exposed to ultraviolet light, it is also possible that these are simply new BCCs occurring within scars in head and neck sites prone to BCCs. Furthermore, these R-SBCCs were not destructive tumours. CONCLUSION: None of the infiltrative foci of DN-SBCCs demonstrated laminin loss. Three of 5 with intra-epithelial actin immunopositivity also demonstrated low bcl-2 and high p53 staining, immunoprofiling these with an aggressive infiltrative component. Of 11 RG-SBCCs with high p53 staining, 4 had high p53 staining in the infiltrative component, but only one had a low bcl-2 composite score and low bcl-2 score in the infiltrative focus. In addition, these infiltrative foci demonstrated intraepithelial MSA positivity and a "VA" immunophenotype of the stromal cells, indicating one RG-SBCC with an established, aggressive immunophenotype. Those positive with one or more, but not all, aggressive immunostains, are hypothesised to be RG-SBCCs evolving/developing an aggressive immunophenotype. Only one R-SBCC, with a predominantly infiltrative pattern, had a "full-house" of aggressive immunostaining in the infiltrative foci: low bcl-2, high p53, 2+ laminin discontinuity and intra-epithelial and stromal MSA positivity. Of significance is that 7 with a predominant nodular pattern had a high p53 score. Of these, 5 had high bcl-2 scores. Hence, while high p53 may be a feature of aggressive growth, it is important that this staining be complemented with that of bcl-2, laminin and MSA. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2006.

The inability to tan properly after sun exposure strongly correlates with increased incidence of skin cancer. The melanocortin 1 receptor (MC1R) is a transmembrane Gs-coupled cell surface receptor found on epidermal melanocytes that transmits pro-survival and pro-differentiation signals mediated by the second messenger cAMP. Humans carrying loss-of-function polymorphisms in MC1R signaling exhibit higher incidences of skin cancers including melanoma. This study focused on the physiologic effects of topical application of forskolin, an adenylate cyclase activator, in extension (Mc1re/e) K14-SCF animals, which model the fair-skinned UV-sensitive human. Twice daily application of the drug promoted accelerated pigmentation, increased skin darkening due to epidermal deposition of melanin pigment, and induced epidermal melanin, which protected the skin against UV injury as judged by “minimal erythematous dose” (MED). Moreover, MC1R signaling regulated the expression of antioxidant enzymes at the transcriptional level. The human melanoma cell line A375, known to harbor a loss-of-function signaling mutation in MC1R, was used to determine effects of cAMP stimulation on the expression of antioxidant enzymes. We observed increases in expression of genes that control the biosynthesis and regulation of glutathione including the transcription factor nuclear factor (erythroid-derived 2)-like 2 (Nrf2), glutathione peroxidase, GPX, and glutathione reductase GSR. In addition, there is an increase in manganese superoxide dismutase (MnSOD) at the protein level. There was accumulation of MnSOD in the mitochondria after pharmacologic induction of cAMP with forskolin. Addition of the oxidative agent H2O2 enhanced the expression of MnSOD at the protein level as early as one hour after MC1R stimulation. Oxygen consumption rate on mitochondria was measured using Seahorse analysis; pharmacologic activation of MC1R/cAMP signaling did not affect mitochondrial metabolism. In addition, topical application of a crude extract of Solidago inhibited UV-induced inflammation in K14-SCF mice. Several UV-induced cytokines, including TNF-α, were down-regulated at the transcriptional level after topical application of Solidago extract. Together, these results indicate that MC1R signaling protects melanocytes from UV damage by regulating antioxidant enzyme expression and suggest that pharmacologic cAMP induction may be a useful preventive mechanism against UV-mediated skin sunburn and oxidative injury.

No description available.

Non–melanoma skin cancer (NMSC) is the most common human malignancy and it is estimated that over 1.3 million cases are diagnosed each year in the United States (Neville et al., 2007:462). There are three main types of NMSC, which include basal–cell carcinoma (BCC), squamous–cell carcinoma (SCC) and cutaneous malignant melanoma (CMM). Exposure to ultra–violet (UV) radiation plays a major role in the aetiology of these three skin cancer types (Franceschi et al., 1996:24). 5–Fluorouracil is an antineoplastic pyrimidine analogue that functions as an anti–metabolite. It interferes with DNA (deoxyribonucleic acid), and to a lesser extent, with RNA (ribonucleic acid) synthesis by blocking the methylation of deoxyuridylic acid into thymidylic acid. It is used in topical preparations for the treatment of actinic keratosis (AK) and NMSC. The cure rate with topical 5–fluorouracil is partly reflected by the degree of erythema, erosions, and eventual crusting which develop at the sites of treatment. This reaction often attains the best clinical response, but in turn, frustrates patients, which may lead to patient incompliance (McGillis & Fein, 2004:175). Due to the hydrophilic nature of 5–fluorouracil, the transdermal permeation through the lipophilic stratum corneum is very low and trivial (Singh et al., 2005:99). Transdermal drug delivery is the delivery of a chemical substance across the skin to reach the systemic circulation (Prausnitz et al., 2004:115). This unique drug transport mechanism suggests many advantages that include safety, patient compliance, user–friendliness, efficiency and non–invasiveness (Fang et al., 2004:241). The stratum corneum is a specialised structure that forms part of several anatomically distinct layers of the skin. Seeing that it is the outermost layer, it provides protection to the skin. It is known as the main barrier to percutaneous absorption of compounds, as well as water loss, through the skin (Bouwstra et al., 2003:4). This study focussed on the formulation of six different types of semisolid formulations, containing 0.5% 5–fluorouracil. The formulations included: a cream, Pheroid cream, emulgel, Pheroid emulgel, lotion and Pheroid lotion. Pheroid refers to a delivery system which was incorporated in the formulations in an attempt to enhance the penetration of 5–fluorouracil into the skin. This drug delivery system consists of unique and stable lipid–based submicronand micron–sized structures, formulated in an emulsion. The dispersed Pheroid structures largely comprise of natural essential fatty acids, which have an affinity for the cell membranes of the human body (Grobler et al., 2008:284–285). These formulations were manufactured in large quantities and stored at three different temperatures, each with their respective relative humidity (RH): 25 °C/60% RH, 30 °C/60% RH and 40 °C/70% RH, for a period of six months. Stability tests were conducted on each of these formulations on the day of manufacture (month 0), and then after 1, 2, 3 and 6 months. The tests included: determination of concentration of the analytes (assay) by means of high performance liquid chromatography (HPLC); determination of zeta–potential and droplet size; pH measurement; viscosity; mass loss determination; physical appearance; and particle size distribution. Franz cell skin diffusion tests were performed with these six 5–fluorouracil containing semisolid formulations (0.5%), as well as with a 0.5% Pheroid solution, 0.5% non–Pheroid solution. A 5.0% Pheroid solution and a 5.0% non–Pheroid solution were also prepared in order to compare the skin diffusion test results to a 5.0% commercially available ointment. The data of the 0.5% formulations and solutions, as well as the 5.0% solutions and commercial ointment, were statistically compared and those formulations (and solutions) that yielded the best results, with regard to % diffused, epidermis and dermis concentrations, were identified. / Thesis (M.Sc. (Pharmaceutics))--North-West University, Potchefstroom Campus, 2011.

Non–melanoma skin cancer (NMSC) is the most common human malignancy and it is estimated that over 1.3 million cases are diagnosed each year in the United States (Neville et al., 2007:462). There are three main types of NMSC, which include basal–cell carcinoma (BCC), squamous–cell carcinoma (SCC) and cutaneous malignant melanoma (CMM). Exposure to ultra–violet (UV) radiation plays a major role in the aetiology of these three skin cancer types (Franceschi et al., 1996:24). 5–Fluorouracil is an antineoplastic pyrimidine analogue that functions as an anti–metabolite. It interferes with DNA (deoxyribonucleic acid), and to a lesser extent, with RNA (ribonucleic acid) synthesis by blocking the methylation of deoxyuridylic acid into thymidylic acid. It is used in topical preparations for the treatment of actinic keratosis (AK) and NMSC. The cure rate with topical 5–fluorouracil is partly reflected by the degree of erythema, erosions, and eventual crusting which develop at the sites of treatment. This reaction often attains the best clinical response, but in turn, frustrates patients, which may lead to patient incompliance (McGillis & Fein, 2004:175). Due to the hydrophilic nature of 5–fluorouracil, the transdermal permeation through the lipophilic stratum corneum is very low and trivial (Singh et al., 2005:99). Transdermal drug delivery is the delivery of a chemical substance across the skin to reach the systemic circulation (Prausnitz et al., 2004:115). This unique drug transport mechanism suggests many advantages that include safety, patient compliance, user–friendliness, efficiency and non–invasiveness (Fang et al., 2004:241). The stratum corneum is a specialised structure that forms part of several anatomically distinct layers of the skin. Seeing that it is the outermost layer, it provides protection to the skin. It is known as the main barrier to percutaneous absorption of compounds, as well as water loss, through the skin (Bouwstra et al., 2003:4). This study focussed on the formulation of six different types of semisolid formulations, containing 0.5% 5–fluorouracil. The formulations included: a cream, Pheroid cream, emulgel, Pheroid emulgel, lotion and Pheroid lotion. Pheroid refers to a delivery system which was incorporated in the formulations in an attempt to enhance the penetration of 5–fluorouracil into the skin. This drug delivery system consists of unique and stable lipid–based submicronand micron–sized structures, formulated in an emulsion. The dispersed Pheroid structures largely comprise of natural essential fatty acids, which have an affinity for the cell membranes of the human body (Grobler et al., 2008:284–285). These formulations were manufactured in large quantities and stored at three different temperatures, each with their respective relative humidity (RH): 25 °C/60% RH, 30 °C/60% RH and 40 °C/70% RH, for a period of six months. Stability tests were conducted on each of these formulations on the day of manufacture (month 0), and then after 1, 2, 3 and 6 months. The tests included: determination of concentration of the analytes (assay) by means of high performance liquid chromatography (HPLC); determination of zeta–potential and droplet size; pH measurement; viscosity; mass loss determination; physical appearance; and particle size distribution. Franz cell skin diffusion tests were performed with these six 5–fluorouracil containing semisolid formulations (0.5%), as well as with a 0.5% Pheroid solution, 0.5% non–Pheroid solution. A 5.0% Pheroid solution and a 5.0% non–Pheroid solution were also prepared in order to compare the skin diffusion test results to a 5.0% commercially available ointment. The data of the 0.5% formulations and solutions, as well as the 5.0% solutions and commercial ointment, were statistically compared and those formulations (and solutions) that yielded the best results, with regard to % diffused, epidermis and dermis concentrations, were identified. / Thesis (M.Sc. (Pharmaceutics))--North-West University, Potchefstroom Campus, 2011.

The melanocortin-1 receptor (MC1R) is a G-protein coupled receptor (GPCR) expressed on the surface of the melanocyte. MC1R activation after UV exposure results in the production of the dark eumelanin pigment and the tanning process in humans, providing protection from UV induced DNA damage. MC1R activation has also recently been linked to DNA repair. The MC1R gene is highly polymorphic in Caucasian populations with a number of MC1R variant alleles associated with red hair, fair skin, poor tanning and increased risk of melanoma and non-melanoma skin cancer. These MC1R variant receptors were thought to be loss of function, however the type of defect and the extent of the loss of function for individual variants was relatively unknown before the commencement of this PhD project. Many GPCR mutant proteins are intracellularly retained, resulting in a loss of signalling ability. To determine if this was the case for MC1R variant receptors, the localisation of the wild type and variant MC1R protein was investigated using immunofluorescence and radio-ligand binding on transfected melanocytic cells as well as primary melanocyte strains. For the first time, several MC1R variants including V60L, R151C, I155T, R160W and R163Q, were shown to have reduced cell surface expression compared to wild type MC1R. cAMP assays were used to determine the signalling ability of activated wild type and variant MC1R, importantly, variant receptors with reduced cell surface expression showed corresponding impairment in cAMP signalling. In contrast, the R142H and D294H variants, which have normal cell surface expression but significantly impaired cAMP signalling, are thought to have a defect in G-protein coupling. Some MC1R variants were found to have dominant negative activity on the wild type receptor in co-expression studies, this result may explain the MC1R heterozygote effect on human pigmentation phenotypes. This dominant negative effect resulted in either reduced wild type cell surface expression or reduced G-protein coupling and may be mediated by receptor dimerisation. In order to validate the in vitro studies, comparison of variant receptor characteristics with skin and hair colour data of individuals both homozygous and heterozygous for MC1R variant alleles was performed. This revealed parallels between variant MC1R cell surface expression, functional ability, dominant negative activity and the strength of the effects of variant alleles on human pigmentation. From the in vitro functional studies, it was clear that most variant receptors retained some signaling ability, although the relative abilities varied. An important unanswered question in the literature was whether the phenotype of carriers of the high penetrance MC1R variant alleles was actually representative of complete loss of function for MC1R. Due to the rarity of MC1R null alleles they had only previously been found in the heterozygous state, however we described the phenotype of one individual compound heterozygous for two frameshift mutations resulting in an individual unable to produce any functional MC1R protein. Phenotypic analysis indicated that red hair and fair skin is found in the absence of MC1R. Finally, preliminary studies using low temperature, chemical or pharmacological chaperones indicated that the cell surface expression of some MC1R variants could be rescued in cell transfection experiments. This resulted in a restoration of signaling ability after stimulation with agonist. These studies into the localization and function of MC1R variants have contributed to a greater understanding of the molecular mechanism underlying the association of MC1R with skin cancer risk phenotypes, and may lead to future drug based therapies that are able to rescue the function of MC1R variants that are intracellularly retained.

No description available.

No description available.

Doctor of Philosophy(PhD) / BCC is the commonest cancer in European-derived populations and Australia has the highest recorded incidence in the world, creating enormous individual and societal cost in management of this disease. The incidence of this cancer has been increasing internationally, with evidence of a 1 to 2% rise in incidence in Australia per year over the last two decades. The main four epidemiological risk factors for the development of BCC are ultraviolet radiation (UVR) exposure, increasing age, male sex, and inability to tan. The pattern and timing of UVR exposure is important to BCC risk, with childhood and intermittent UVR exposure both associated with an increased risk. The complex of inherited characteristics making up an individual’s ‘sun sensitivity’ is also important in determining BCC risk. Very little is known about population genetic susceptibility to BCC outside of the rare genodermatosis Gorlin syndrome. Mutations in the tumour suppressor gene patched (PTCH) are responsible for this BCC predisposition syndrome and the molecular pathway and target genes of this highly conserved pathway are well described. Derangments in this pathway occur in sporadic BCC development, and the PTCH gene is an obvious candidate to contribute to non-syndromic susceptibility to BCC. The melanocortin 1 receptor (MC1R) locus is known to be involved in pigmentary traits and the cutaneous response to UVR, and variants have been associated with skin cancer risk. Many other genes have been considered with respect to population BCC risk and include p53, HPV, GSTs, and HLAs. There is preliminary evidence for specific familial aggregation of BCC, but very little known about the causes. 56 individuals who developed BCC under the age of 40 in the year 2000 were recruited from the Skin and Cancer Foundation of Australia’s database. This represents the youngest 7 – 8% of Australians with BCC from a database that captures approximately 10% of Sydney’s BCCs. 212 of their first degree relatives were also recruited, including 89 parents and 123 siblings of these 56 probands. All subjects were interviewed with respect to their cancer history and all reports of cancer verified with histopathological reports where possible. The oldest unaffected sibling for each proband (where available) was designated as an intra-family control. All cases and control siblings filled out a questionnaire regarding their pigmentary and sun sensitivity factors and underwent a skin examination by a trained examiner. Peripheral blood was collected from these cases and controls for genotyping of PTCH. All the exons of PTCH for which mutations have been documented in Gorlin patients were amplified using PCR. PCR products were screened for mutations using dHPLC, and all detectable variants sequenced. Prevalence of BCC and SCC for the Australian population was estimated from incidence data using a novel statistical approach. Familial aggregation of BCC, SCC and MM occurred within the 56 families studied here. The majority of families with aggregation of skin cancer had a combination of SCC and BCC, however nearly one fifth of families in this study had aggregation of BCC to the exclusion of SCC or MM, suggesting that BCCspecific risk factors are also likely to be at work. Skin cancer risks for first-degree relatives of people with early onset BCC were calculated: sisters and mothers of people with early-onset BCC had a 2-fold increased risk of BCC; brothers had a 5-fold increased risk of BCC; and sisters and fathers of people with early-onset BCC had over four times the prevalence of SCC than that expected. For melanoma, the increased risk was significant for male relatives only, with a 10-fold increased risk for brothers of people with early-onset BCC and 3-fold for fathers. On skin examination of cases and controls, several phenotypic factors were significantly associated with BCC risk. These included increasing risk of BCC with having fair, easyburning skin (ie decreasing skin phototype), and with having signs of cumulative sun damage to the skin in the form of actinic keratoses. Signs reflecting the combination of pigmentary characteristics and sun exposure - in the form of arm freckling and solar lentigines - also gave subjects a significantly increased risk BCC. Constitutive red-green reflectance of the skin was associated with decreased risk of BCC, as measured by spectrophotometery. Other non-significant trends were seen that may become significant in larger studies including associations of BCC with propensity to burn, moderate tanning ability and an inability to tan. No convincing trend for risk of BCC was seen with the pigmentary variables of hair or eye colour, and a non-significant reduced risk of BCC was associated with increasing numbers of seborrhoeic keratoses. Twenty PTCH exons (exons 2, 3, 5 to 18, and 20 to 23) were screened, accounting for 97% of the coding regions with published mutations in PTCH. Nine of these 20 exons were found to harbour single nucleotide polymorphisms (SNPs), seen on dHPLC as variant melting curves and confirmed on direct sequencing. SNPs frequencies were not significantly different to published population frequencies, or to Australian general population frequencies where SNP database population data was unavailable. Assuming a Poisson distribution, and having observed no mutations in a sample of 56, we can be 97.5% confident that if there are any PTCH mutations contributing to early-onset BCC in the Australian population, then their prevalence is less than 5.1%. Overall, this study provides evidence that familial aggregation of BCC is occurring, that first-degree relatives are at increased risk of all three types of skin cancer, and that a combination of environmental and genetic risk factors are likely to be responsible. The PTCH gene is excluded as a major cause of this increased susceptibility to BCC in particular and skin cancer in general. The weaknesses of the study design are explored, the possible clinical relevance of the data is examined, and future directions for research into the genetics of basal cell carcinoma are discussed.