Photodynamic therapy (PDT) is a multimodality cancer treatment available for the palliation or eradication of systemic and cutaneous malignancies. In this thesis, the application of PDT is for the treatment of non-melanoma skin cancer (NMSC). While PDT has a well-documented track record, there are, at this time no significant indicators to suggest the superiority of one treatment regime over the next. The motivation for this work is to provide additional evidence pertaining to PDT treatment variables, and to assist in optimising PDT treatment regimes. One such variable is the treatment light dose. Determining the light dose more accurately would assist in optimising treatment schedules. Furthermore, choice of photosensitiser pro-drug type and application times still lack an evidence base. To address issues concerning treatment parameters, fluorescence spectroscopy – a valuable optical diagnostic technique – was used. Monitoring the in vivo PpIX fluorescence and photobleaching during PDT was employed to provide information pertaining to the progression of treatment. This was demonstrated by performing a clinical study at the Photobiology Unit, Ninewells Hospital and Medical School, Dundee. Two different photosensitiser pro-drugs – either 5-aminolaevulinic acid (ALA) or its methyl ester (MAL) – were investigated and based on the fluorescence and pain data recorded both may be equally suitable for topical PDT. During PDT, surface fluorescence is observed to diminish with time – due to photobleaching – although cancerous cells may continue to be destroyed deep down in the tissue. Therefore, it is difficult to ascertain what is happening at depth in the tumour. This raised the questions; How long after surface PpIX fluorescence has diminished is the PDT treatment still effective and to what depths below the surface is effective treatment provided? In order to address these important questions, a three-dimensional (3D) Monte Carlo radiation transfer (MCRT) model was used to compute the light dose and the ¹O₂ production within a tumour, and the PpIX fluorescence emission from the tumour. An implicit dosimetry approach based on a single parameter – fluorescence photobleaching – was used in order to determine the ¹O₂ generation, which is assumed to be related to tissue damage. Findings from our model recommended administering a larger treatment light dose, advocating an increase in the treatment time after surface PpIX fluorescence has diminished. This increase may ultimately assist in optimising PDT treatment regimes, particularly at depth within tumours.

No description available.

Le rayonnement UV solaire induit des modifications de la structure chimique des bases nucléiques de l'ADN essentiellement au niveau de site dipyrimidinique et conduit principalement à la formation des adduits cyclobutanique et (6-4). Ces adduits sont impliqués dans le photovieillisement et le cancer cutané. Les adduits (6-4) sont potentiellement les plus dangereux en raison de leurs propriétés mutagènes intrinsèques.La conformation de l'ADN représente l'un des facteurs gouvernant la formation de l'adduit (6-4). Afin, d'identifier les paramètres structuraux favorisant sa formation, des analogues du dinucléotide de thymine, de conformation choisie, ont été synthétisés. Les modifications chimiques apportées au sein des dinucléotodes ont permis de déplacer l'équilibre conformationnel Nord/Sud du désoxyribose de la thymidine, vers une conformation majoritaire souhaitée. Une analyse structurale par dichroïsme circulaire et une étude préliminaire de photoréactivité ont été réalisées sur ces dinucléotides modifiés. Les résultats obtenus révèlent l'implication de formes minoritaires empilées de ces dinucléotides dans la formation de l'adduit (6-4). De plus, l'étude photochimique montre que l'augmentation de conformères Nord et Sud du dinucléotide aux extrémités 5' et 3', respectivement, favorise la formation de l'adduit (6-4). Cependant, une conformation totalement contrainte Nord et Sud aux extrémités 5' et 3', respectivement, défavorise sa formation.Ces résultats ont permis d'identifier une conformation augmentant le rendement de formation de l'adduit (6-4) et permettront de concevoir de nouveaux modèles conduisant à la formation exclusive de ces adduits. Ces modèles pourront être utilisés en biologie en vue d'applications thérapeutiques ou comme outil en biophysique afin d'élucider le mécanisme de formation de cet adduit. / Exposure of DNA to solar UV light induces chemical modifications on its nucleic bases that are responsible for photoaging and skin cancer. Two major DNA photoproducts class exist: cyclobutane and (6-4) adducts. The latter is intrinsically more mutagenic than the cyclobutane adduct and therefore potentially more dangerous.DNA conformational parameters influence (6-4) adducts formation. To identify structural factors governing (6-4) adduct formation; we synthesized dinucleotides endowed with a specific conformation. Nucleoside moieties exist in a dynamic equilibrium between North and South conformation. Nucleoside conformational changes have been introduced by chemical modifications to obtain desired conformations. Then a structural study by circular dichroism correlated with photochemical study was done. It showed that minor stacked conformers promote (6-4) adduct formation. Moreover, the photochemical study reveals that the increase of North and South conformers at the 5' and 3' end, respectively, increased (6-4) adduct formation but a locked dinucleotide almost precluded (6-4) adduct formation. This result helps to design new models favoring (6-4) adduct formation. Understanding the conformational parameters that govern (6-4) adduct formation will facilitate the development of new therapeutic strategies and the elucidation of the (6-4) adducts formation mechanism.

No description available.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The present study employed a two-phased approach to investigate the possible mechanisms involved in the chemopreventive properties of rooibos (Aspalathus linearis) and different honeybush species (Cyclopia spp.) in vitro. In the first phase, the effect of unfermented methanol and aqueous herbal tea extracts against the growth parameters (cell viability, proliferation and apoptosis) of normal (CRL 7761); premalignant (HaCaT); and malignant (CRL 7762) skin cells was evaluated and compared to green tea extracts. The predictive potential of polyphenol content (total polyphenol and flavanol/proanthocyanidins) and antioxidant properties (ABTS; ORAC; FRAP and LPO) in the biological activity of extracts in cells was also assessed. Of the herbal teas, the methanol extract of rooibos was the most active and it inhibited the growth of skin cells presumably by inducing mitochondrial dysfunction via membrane depolarisation. At lower concentrations, this activity was associated with inhibition of cell proliferation that was selective for cancer cells whilst higher concentrations induced apoptosis that was more prominent in premalignant cells. The strong antioxidant properties of the extracts implicated the role of pro-oxidative polyphenol/iron interactions involving monomeric flavonoids and polymeric proanthocyanidins in the cytotoxic effects of rooibos. The strong relationship between total polyphenolic and flavanol/proanthocyanidins content, antioxidant properties and reduction of cell viability indicated that these parameters (polyphenols and antioxidant properties) can serve as predictive tools for the cytotoxic effects of rooibos in vitro. The aqueous extracts of honeybush species, although weaker, displayed similar effects to rooibos extracts in cells with C. genistoides being the most effective at selectively inhibiting the proliferation of cancer cells whilst the pro-apoptotic activity of C. subternata and C. intermedia was more prominent in premalignant cells. The underlying mechanisms are also likely to result from pro-oxidative mechanisms resulting from polyphenol/iron interactions that mainly involve polymeric flavanol-like proanthocyanidin compounds in honeybush. In contrast, the methanol extracts exhibited weaker cytotoxic effects and protected cancer cells from going into apoptosis. The cytoprotective effects of honeybush species are possibly mediated by the major monomeric compounds such as mangiferin and hesperidin through antioxidant mechanisms that result in reduction of oxidative stress. Due to the possible dual role of the monomeric and polymeric compounds in the honeybush extracts, the total polyphenolic content of these herbal teas may not be a good indicator of biological activity in vitro. However, as aqueous extracts displayed high flavanol/proanthocyanidins content and exceptional activity in the ABTS assay, these parameters may be considered as indicators of cytotoxicity. On the other hand, methanol extracts, particularly from the xanthone-rich species (C. genistoides and C. longifolia) which exhibited the weakest cytotoxic effects, were more active in the ORAC thus this assay may be a useful predictor for cytoprotective activity. In the second phase, an in vitro UVB/HaCaT model which used IL-1α as a biomarker for early inflammation was developed and validated with known anti-inflammatory compounds, dexamethasone and ibuprofen. It was used to determine the specific mechanisms involved in the modulatory effects of the herbal tea extracts against inflammation. Rooibos extracts and the aqueous extract of honeybush enhanced the cytotoxic effects of UVB in the model and exhibited indirect anti-inflammatory effects as they removed icIL-1α containing cells via apoptosis. In contrast, methanol extracts of honeybush exacerbated icIL-1α by protecting UVB stimulated cells from undergoing apoptosis. In conclusion, methanol extract of rooibos and aqueous extracts of honeybush species may be useful in protecting the skin after UVB exposure. These herbal tea extracts may block initiation and delay the promotion stage during skin carcinogenesis by removing premalignant cells via apoptosis and preventing onset of inflammation. In contrast, due to their cytoprotective effects, methanol extracts of honeybush may be more effective at preventing oxidative stress in skin before UVB exposure. Future studies should focus on the effects of extracts and polyphenolic fractions on the oxidative status of the cells and development of biomarkers of chemoprevention that can be utilised in vivo and in human skin. / AFRIKAANSE OPSOMMING: In hierdie studie word moontlike velkankerwerende eienskappe van rooibos (Aspalathus linearis) en ‘n aantal heuningbos (Cyclopia spp.) spesies deur twee afsonderlike benaderings bestudeer. Die eerste benadering ondersoek die effek van die kruietee op groeiparameters van velselle [lewensvatbaarheid, groei en dood van normale selle (CRL 7761), vroeë kankerselle (HaCaT) en kankerselle (CRL 7762)]. Tydens eksperimente is die moontlikheid om polifenoolinhoud (totale polifenole, en flavanol/proantosianidiene verhouding) en antioksidant-eienskappe te gebruik om die biologiese funksies van die ekstrakte in die selle te voorspel, geevalueer. Die metanolekstrak van rooibos het die groei van selle die effektiefste gestop, moontlik deur depolarisasie van die mitokondriale membraan. By lae konsentrasies van die ekstrak is die groei van kankerselle selektief gestop, terwyl vroeë kankerselle die sensitiefste by hoër konsentrasies was. Die hoë antioksidant-aktiwiteit van die rooibosekstrak kan moontlik ‘n rol speel in die indusering van sitotoksiese effekte in die selle en kan toegeskryf word aan die pro-antioksidant aktiwiteit van die polifenole weens hul interaksie met yster. ‘n Spesifieke funksie word vir die monomeriese flavonoïede en die polimeriese proantosianidiene geïmpliseer. Die sterk verwantskap tussen die totale polifenoolinhoud, flavanol/proantosianidien inhoud en antioksidant aktiwiteit met die verlaging in selgroei, maak hul relevante parameters van die voorspellingsmodel. Die waterekstrakte van heuningbos induseer ook soortgelyke maar swakker effekte met die induksie van kankersel dood, met C. genistoides die selektiefste en C. subternata en C. intermedia die aktiefste spesies wat die groei van die vroeë kanker selle inhibeer. Die onderliggende meganismes betrokke blyk ook aan ‘n pro-oksidant effek toe geskryf te wees, waartydens spesifieke polifenool/yster interaksies betrokke is. In teenstelling met rooibos, beskerm die metanolekstrak van heuningbos kankerselle teen seldood, wat moontlik verband hou met die antioksidant-eienskappe van die hoof monomeriese polifenole, mangiferien/isomangiferien en hesperidien. Vanweë die dubbele rol van die monomeriese polifenole en polimeriese verbindings in heuninghbosekstrakte is die totale polifenol inhoud nie ‘n goeie indikator van die biologiese aktiwiteit in vitro nie. Daarenteen is die flavanol/proantosianien inhoud en die hoë aktiwiteit in die ABTS antioksidanttoets goeie indikators om seldood te voorspel. In teenstelling hiermee het die metanolekstrakte van die xantoon-ryke spesies (C. genistoides en C. longifolia) ‘n baie lae effek op seldood, maar ‘n hoë aktiwitiet in die ORAC toets getoon, wat ‘n goeie rigtingwyser is om die beskermende effek in selle te voorspel. Met die tweede benadering is die anti-inflammatoriese eienskappe en die onderliggende meganismes van die kruietee ondersoek in ‘n UVB/HaCaT selmodel. Intrasellulêre interleukin 1α (IL-1α) is as merker gebruik en die model is geëvalueer deur bekende anti-inflammatoriese verbindings soos dexamethasone en ibuprofin te gebruik. Die metanolekstrak van rooibos en die waterekstrak van heuningbos het die toksiese effek van UVB in die model verhoog deur selle met verhoogde vlakke,van icIL-1α te verwyder deur middel van die induksie van seldood. Die metanolekstrak beskerm die selle teen die oksidatiewe skade wat deur UVB geïnduseer word en verwyder nie selle met hoë IL-1α vlakke nie. Ter opsomming blyk dit dat die metanolekstrak van rooibos en die waterekstrak van heuningbos moontlik gebuik kan word om die vel te beskerm teen die induksie van icIL-1α en sodoende die inisiëring van kanker te blokkeer en ook die promosie van kanker te vertraag. Die beskermende effek van die metanolekstrak kan moontlik aangewend word om die oksidatiewe skade wat deur UVB veroorsaak word teen te werk deur dit aan te wend voordat blootstelling plaasvind. Toekomstige studies behoort verdere karakterisering van die polifenoolsamestelling van die ekstrakte in te sluit en hul effek op die oksidatiewe status en anti-inflammoriese effekte van selle te bepaal ten einde sekere merkers te identifiseer vir vel studies in vivo.

The topical application of sunscreens is widely practised to protect healthy and photosensitive skins from the sun. The benzophenone-derived sunscreens, e.g. 2-hydroxy-4-methoxy benzophenone-5-sulphonic acid (or benzophenone-4) and 2-hydroxy-4-methoxy benzophenone (or benzophenone-3), were ranked as the second and third most frequently used sunscreens, respectively, by the United States Food and Drug Administration (FDA) in 1996. These sunscreens are categorised as being 'safe' and 'effective'. However, it is well known that the parent compound, benzophenone, undergoes rapid hydrogen abstraction reactions on irradiation and is an extremely powerful radical generator. In addition, benzophenone has been shown to be a potent photosensitizer of thymine dimers in deoxyribose nucleic acid (DNA). More astounding to the sunscreen industry is the recent discovery that a group of non-steroidal anti- inflammatory drugs (NSAIDs) having the benzophenone backbone, e.g. ketoprofen, not only form thymine dimers when irradiated with DNA in vitro, but also photosensitize double stranded supercoiled DNA making it prone to single-strand break formation. Both these lesions, if unrepaired, may contribute to mutagenesis, carcinogenesis, inherited disease and eventually cell death. The purpose of this investigation was to determine if a group of benzophenone-derived sunscreen agents has the ability to photosensitize the cleavage of DNA, whereby supercoiled DNA is converted to the relaxed circular and linear forms. The group of UV absorbers investigated in this study included benzophenone-4, benzophenone-3 , 2,4 dihydroxybenzophenone (or benzophenone-l), 2,2'-dihydroxy-4,4'-dimethoxy benzophenone sulphonic acid (or trade name Uvinul DS49) and 2-phenylbenzimidazole-5-sulphonic acid (or trade name Eusolex 232). For comparison the parent compound benzophenone and the NSAID ketoprofen, a well-known photocleaver, were also studied. Buffered aqueous solutions of the benzophenones were irradiated in the presence of DNA at wavelengths greater than 300 nm with an Osram 500 W/2 high-pressure mercury lamp in conjunction with a 10 mm thick Pyrex filter. The irradiated samples were analysed for DNA cleavage by agarose gel electrophoresis and for DNA binding by fluorescence spectroscopy. The photostability of the UV absorbers was also investigated. In addition, computational studies were conducted to obtain the lowest energy geometrical structures of these UV absorbers and hence determine if intercalation of these UV absorbers with DNA was possible. From the photostability experiments conducted, it is apparent that the benzophenone-based UV absorbers were stable to photodecomposition when irradiated with UV light. They behaved in a manner different from their parent compound benzophenone, and from ketoprofen, where substantial photodegradation occurred upon UV irradiation. This is indicative of the rapid photoreactivity of the benzophenone backbone. The relative photostability of the UV absorbers was not anticipated and was attributed to the substituents present on the benzophenone backbone. The agarose gel electrophoresis experiments however clearly showed that benzophenone, ketoprofen, benzophenone-l, Uvinul DS49 and Eusolex 232 cleave ?X174 DNA when irradiated with UV light at wavelengths greater than 300 nm, while benzophenone-3 and benzophenone-4 did not. For these UV absorbers with the exception of benzophenone-3 and benzophenone-4, the number of single strand breaks in the DNA increased compared to when it was irradiated in their absence. In addition, the supercoiled DNA was converted to the relaxed circular and linear forms, the latter of which was undetected in the absence of the UV absorbers. Binding of benzophenone, ketoprofen, benzophenone-l and Uvinul DS49 to calf thymus DNA was also detected by the fluorescence spectroscopy technique. However, this was not observed for Eusolex 232, benzophenone-3 and benzophenone-4, since they did not compete with ethidium bromide for DNA binding sites. Where DNA cleavage did occur, the mechanism of this interaction had to be determined hence the motivation for the computational studies. From computational studies using PM3 semi- empirical calculations, it was determined that the benzophenone-based UV absorbers investigated, apart from Eusolex 232, displayed non-planar geometrical structures. This indicated that DNA intercalation of these sunscreen agents with DNA would at best be very limited, since only one half of the molecule could possibly interact with the bases of DNA. For benzophenone, ketoprofen, benzophenone-l and Uvinul DS49, photosensitised type I and type II processes involving triplet energy transfer reactions has been identified in literature as being responsible for DNA cleavage. It was determined by ab initio calculations that Eusolex 232 exists in a planar structure unlike the other UV absorbers mentioned above that were non- planar. It was concluded that although Eusolex 232 has the ability to intercalate with the base pairs of DNA, it does not do so, as shown by its lack of binding to calf thymus DNA by the fluorescence spectroscopy study. Literature alludes to photooxidation by singlet oxygen in single stranded DNA via the type II reaction and type I electron transfer reactions in double stranded DNA as the mechanism responsible for DNA cleavage induced by Eusolex 232. / Thesis (M.Sc.)-University of Natal, Durban, 2003.

Nucleotide excision repair (NER) is one of the major repair systems for removal of DNA lesions. The NER pathway has evolved mainly to repair UV-induced DNA damage and is also active against a broad range of endogenously generated oxidative lesions. Defects in NER result in the human inherited disorder xeroderma pigmentosum (XP), which is characterised by UV hypersensitivity and a 1000-fold increased risk of skin cancer. ERCC1 is essential for the NER pathway where it acts in a complex with the XPF protein to make the incision 5' to the DNA lesion. The normal 1.1kb Ercc1 transcript is expressed in all tissues. Our group has discovered a second larger 1.5 kb transcript, which initiates from an alternative promoter, and is the most abundant Ercc1 transcript in mouse skin. The aims of this project were: 1, To investigate the role of ERCC1 and of the 1.5kb skin specific Ercc1 transcript in protecting the skin against UV-induced DNA damage. 2, To study the importance of ERCC1 in melanoma skin cancer and investigate ERCC1as a possible target for therapy against melanoma. Using a panel of Ercc1 wild-type and deficient cells, we established a quantitative western blotting system to study the expression of ERCC1 in a range of mouse tissues and mouse and human cell types. Although the skin-specific Ercc1 transcript was found to be present at much higher levels in the skin of albino compared to pigmented mouse strains, this did not result in an elevated level of ERCC1 protein. We were also unable to demonstrate that UV-irradiation, or other stress-inducing treatments resulted in increased levels of ERCC1 protein in cultured mouse keratinocytes. We investigated the DNA methylation status of the normal Ercc1 promoter and that of two potential upstream promoter regions that were candidates for the source of the 1.5kb skin-specific Ercc1 transcript. We found no evidence that they were the source and, instead, used 5' RACE analysis to locate the skin-specific promoter to a polymorphic region 500bp upstream of the normal initiation site. In albino strains this region contains a SINE element, which we hypothesize could be involved in the production of the skin-specific Ercc1 transcript. We also investigated the protein level of ERCC1 and other DNA repair proteins, including XPF, MSH2, MSH6 and MLH1 in human melanoma cells and ovarian tumour cells. Significantly elevated protein levels of ERCC1 and XPF, as well as the mismatch repair protein MLH1 were found in melanoma cells. This could possibly contribute to the higher resistance to chemotherapy in melanoma, although the melanoma cell lines we tested did not show increased resistance to UV and cisplatin compared to the ovarian cancer cells tested. When Ercc1 proficient mouse melanoma cells were xenografted into nude mice the xenografts grew rapidly. Cisplatin treatment caused an initial shrinkage of the tumours, but re-growth rapidly followed. Cells re-isolated into culture from cisplatin treated xenografts had significantly higher levels of ERCC1 protein than either input cells, or cells re-isolated from untreated xenografts. An isogenic Ercc1 deficient derivative of the Ercc1 proficient mouse melanoma cell line grew as rapidly as the parent line in vitro, but grew much more slowly as xenografts. In addition, the xenografts shrank completely following cisplatin treatment and did not recover. This suggests that ERCC1 could be a drug target for melanoma therapy.

Background. Skin cancer is the most common form of cancer in the United States. The main modifiable risk factor for skin cancer is exposure to excessive sun and UV radiation. More than 90% of all skin cancers are known to be caused by sun exposure. However, studies on excessive sun and UV exposure are limited. The purpose of this study was to examine risk and protective factors affecting sun protection behaviors of adult women in the United States. Methods. Data on U.S. adult women (n=17,425) from the 2003 National Health Information Survey (NHIS) was analyzed. Sun protection behaviors were assessed using three variables: use of sunscreen, staying in the shade, and wearing protective clothing when outside for an hour or more on a very sunny day. Demographic characteristics, risk and preventive factors such as visit to the general doctor, visit to the dentist, most recent mammogram, most recent pap smear, vigorous exercise, cigarette use, and alcohol use were examined using multiple logistic regression. Results. Only 45% of the respondents indicated that they consistently use sunscreen or stay in the shade when outside on a very sunny day for an hour or more and 15.8% of the respondents reported that they consistently wore protective clothing. The adjusted logistic regression analyses indicated that race, age, education, income, geographic region, employment status, exercise, history of cancer, tobacco use, and alcohol use were statistically significant predictors for participation in the sun protection behaviors. Conclusions. A majority of the U.S. adult female population do not use protection from excessive sun. Education programs for sun protection behaviors should target young, low income women with less than high school education who participate in other health risk behaviors, such as tobacco and alcohol use. Furthermore, sun protection education should be incorporated with other health education messages that target at risk populations.

Le rayonnement ultraviolet (UV) est un cancérigène pour lequel peu d’informations sur l’exposition des populations est disponible. L’intensité et les variations de l’exposition au rayonnement UV solaire, principale source d’exposition, a un impact sur la santé mais il est difficile de les surveiller. Le travail de cette thèse a permis de développer un outil pour une estimation quantitative de l’exposition individuelle à l’UV solaire pour l’épidémiologie. Nous avons créé un atlas des moyennes mensuelles d’irradiation journalière en Europe. Certaines données manquantes au niveau des pays nordiques en hiver ont dû être extrapolées. Nous avons vu que la saisonnalité est forte et que la répartition spatiale ne suit pas seulement le gradient de latitude. Par exemple, l’irradiation UV est plus élevée au sud des pays nordiques qu’au centre de l’Europe. Une enquête a été menée dans huit populations européennes afin d’estimer l’exposition individuelle. Ces populations ont des comportements différents vis-à-vis de l’exposition au soleil. Après une étape de modélisation pour estimer les données d’irradiation UV manquantes au nord de la Norvège sur l’ensemble de l’année, nous avons pu quantifier l’exposition chronique et l’exposition pendant les vacances dans trois populations (française, italienne et norvégienne). L’outil développé au cours de cette thèse pourra être utilisé pour de futures études épidémiologiques qui permettront de connaître l’exposition au rayonnement ultraviolet solaire de populations et de mieux comprendre son rôle dans l’étiologie de diverses maladies, telles que les cancers cutanés. / Ultraviolet radiation (UV) is a carcinogenic agent for which little information on human exposure is available. The intensity and the changes of solar UV exposure, which is the main source of exposure, have an impact on health but are difficult to monitor. The work of this thesis led to the creation of a tool for quantitative estimation of individual exposure to solar UV that can be used in epidemiological studies. We created an atlas of monthly average daily radiation across Europe. Some missing values from the Nordic countries during winter had to be extrapolated. We observed a strong seasonality and characteristics in the spatial distribution which does not always follow the gradient of latitude. For instance, UV radiation is higher in the southern area of the Nordic countries than in central Europe. A survey was conducted in eight European populations to estimate individual exposure. These populations have different behaviours regarding sun exposure. After a step of modeling to estimate missing values in northern Norway throughout the year, we quantified chronic and holiday exposure in three populations (France, Italy and Norway). The tool developed during this thesis will be used for future epidemiological studies that will contribute to improving the knowledge about UV exposure in populations and better understanding its role in the aetiology of various diseases, such as skin cancers.

Introduction. Sunbeds emit ultraviolet (UV) radiation to produce a cosmetic tan and are classified by the World Health Organization as first-group carcinogens: they have been significantly associated with increased risk of melanoma and non-melanoma skin cancer. Despite this, controversies still exist: since sunbeds are able to increase serum vitamin D, the sunbed industry relentlessly tries to promote them as a safe therapeutic measure; and some authors have recently expressed scepticism about the carcinogenicity of sunbeds. Moreover, differences between European countries in terms of prevalence of use have not been extensively studied and a better understanding of the determinants of use in Europe is much needed. Similarly, the association of sunbed use with skin cancer risk factors is poorly understood. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants’ data, including sunbed use and phenotype, are collected via questionnaires.Objectives. To thoroughly describe prevalence, determinants, and risks associated with sunbed use in Europe. To this aim we performed literature reviews (3 publications) and an extensive analysis of the Euromelanoma database, which included data from 30 European countries (2 publications).Methods. For the 3 reviews we searched the most used databases for any literature published in English using all pertinent keywords. As for the 2 Euromelanoma studies, participants filled in questionnaires about demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for all confounders were employed to assess factors independently associated with sunbed use in each country.Results. Our reviews showed that: (i) European sunbed users are typically young women, sun seekers, and smokers, mostly from northern countries, going to tanning studios with aesthetic motives, although exceptions exist; (ii) in case of vitamin D deficiency, the risk/benefit ratio is clearly in favour of vitamin D supplementation instead of sunbed use; (iii) all epidemiological criteria for causality apply to the relationship between sunbed use and melanoma. The Euromelanoma studies included 227,888 individuals (67.4% females, median age 44) from 30 countries. Overall prevalence of sunbed ever use was 10.6%. Prevalence was higher in northern, sun-deprived countries, with the exception of Italy and Spain. Females displayed higher prevalence than males in all countries. Geographic particularities were found in four regions: Iberian (prevalence ten times higher in Spain than Portugal), Balkan (prevalence disproportionately higher among women), Baltic (highest prevalence among young adults), and Scandinavian (highest prevalence among adolescents). Ever sunbed use was independently associated with nevus count >50 [summary odds ratio (SOR)=1.05 (1.01-1.10)], atypical nevi [SOR=1.04 (1.00-1.09)], lentigines [SOR=1.16 (1.04-1.29)], and suspicion of melanoma [SOR=1.13 (1.00-1.27)]. Conclusions. After a thorough literature revision, we concluded that the debate over whether sunbed use contributes to melanoma should be definitively closed and that sunbeds are not a safe option to increase vitamin D levels. The Euromelanoma analysis on sunbeds and skin cancer risk factors suggests that avoidance/discontinuation of sunbed use should always be encouraged, especially, but not exclusively, for individuals with high-risk phenotypes. The data about prevalence/determinants of sunbed use have public health relevance for future, tailored interventions aimed at reducing indoor tanning in Europe. / Introduction. Les bancs solaires émettent des radiations ultraviolettes (UV) pour induire un bronzage cosmétique. Ils sont classés par l’Organisation Mondiale de la Santé comme carcinogènes de premier groupe: ils sont significativement associés à un risque accru de mélanome et de cancers cutanés non-mélanome. Malgré ça, des controverses existent toujours :comme leur utilisation permet d’accroitre le taux sérique de vitamine D, l’industrie du bronzage artificiel n’a cessé de les promouvoir comme thérapeutique sans danger et certains auteurs ont récemment mis en doute la carcinogénicité des bancs solaires. Par ailleurs, les différences entre les pays européens en terme de prévalence et de facteurs déterminant l’utilisation des bancs solaires n’ont pas été clairement étudiées. De la même façon, la relation entre bronzage artificiel et facteurs de risque de cancérisation cutanée reste floue. Euromelanoma est une campagne pan-européenne annuelle de prévention de cancers cutanés, où des questionnaires récoltent les données des participants (usage des bancs solaires, phénotype et informations cliniques inclus).Objectifs. Décrire de manière approfondie la prévalence, les déterminants et les risques associés à l’utilisation des bancs solaires en Europe. Dans ce but, nous avons réalisé des revues de littérature (3 publications) et une analyse extensive de la base de données Euromelanoma qui couvre 30 pays européens (2 publications).Méthodes. Pour les 3 revues, nous avons cherché dans toute la littérature publiée en anglais sur les moteurs de recherche les plus utilisés, en employant des mots clés pertinents. Les participants des 2 études Euromelanoma ont rempli des questionnaires colligeant les facteurs démographiques et de risque, le type et la durée d’utilisation des bancs solaires. Des analyses multi-variées ont permis d’évaluer les facteurs indépendamment associés à l’usage des bancs solaire dans chaque pays.Résultats. Les revues de littérature ont montré que :(i) les utilisateurs européens sont typiquement des femmes jeunes/adultes, amatrices de soleil, fumeuses, ressortissantes des pays nordiques, motivées par des raisons esthétiques et préférant les centres de bronzage, même si des exceptions existent ;(ii) dans le cas d’une carence en vitamine D, le rapport risque/bénéfice est clairement en faveur de la supplémentation en vitamine D plutôt que du bronzage artificiel ;(iii) tous les critères épidémiologiques de causalité s’appliquent à la relation entre les bancs solaires et le mélanome. Les études Euromelanoma ont été réalisées sur 227,888 individus (67.4% femmes, âge médian 44 ans) issus de 30 pays. La prévalence globale d’utilisation des bancs solaires était 10.6%, mais était plus élevée dans les pays nordiques et non ensoleillés, l’Italie et l’Espagne faisant exception. Dans tous les cas, les femmes avaient une prévalence d’utilisation plus élevée que les hommes. Des particularités géographiques ont été relevées dans 4 régions :la péninsule ibérique (prévalence 10 fois plus élevée en Espagne qu’au Portugal), les Balkans (disproportions excessives de prévalence entre femmes et hommes), les pays baltiques (la prévalence la plus élevée chez les jeunes/adultes), et scandinaves (la prévalence la plus élevée chez les adolescents). Avoir utilisé au moins une fois un banc solaire était indépendamment associé avec :un nombre de naevi >50 [summary odds ratio (SOR)=1.05 (1.01-1.10)], la présence de naevi atypiques [SOR=1.04 (1.00-1.09)] et des lentigines [SOR=1.16 (1.04-1.29)] et la suspicion de mélanome [SOR=1.13 (1.00-1.27)]. Conclusions. La revue complète de la littérature nous permet d’affirmer que le débat sur la relation causale entre bancs solaires et mélanome doit être clos et que leur utilisation pour corriger un déficit sérique en vitamine D n’est pas sans danger. L’analyse Euromelanoma sur l’utilisation des bancs solaires et les facteurs de risque de cancer cutané suggère que le bronzage artificiel devrait toujours être dissuadé, spécialement mais pas exclusivement chez les individus avec des phénotypes à haut risque. Les données de la prévalence et des facteurs déterminant l’utilisation des bancs solaires constituent un intérêt de santé publique et devraient permettre de cibler les actions nécessaires à la réduction du bronzage artificiel en Europe. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished