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Background It is well known that solar radiation accelerates skin photoaging. To evaluate subclinical photodamage in the skin especially from the early phase of ultraviolet (UV)-induced damage, we have focused on ultraweak photon emission (UPE), also called biophotons. Our previous study reported that the amount of long-lasting UPE induced by UV, predominantly from lipid peroxidation, is a valuable indicator to assess cutaneous photodamage even at a suberythemal dose, although it was only applied to evaluate acute UV damage. The aim of this study was to further investigate whether long-lasting UPE could also be a useful marker to assess subclinical chronic sun damage in the course of skin photoaging. Materials and methods Forty-three Japanese females in their 20s were recruited and were divided into two groups according to their history of sun exposure based on a questionnaire (high- and low-sun-exposure groups). Several skin properties on the cheek and outer forearm were measured in addition to UV-induced UPE. Results Among the skin properties measured, water content, average skin roughness, and the lateral packing of lipids in the stratum corneum were significantly deteriorated in the high-sun-exposure group as were changes in some skin photoaging scores such as pigmented spots and wrinkles. In addition, those skin properties were correlated with the UPE signals, suggesting the possible impact of oxidative stress on chronic skin damage. Conclusion Subtle oxidative stress detected by long-lasting UPE may contribute to subclinical cutaneous damage at the beginning phase of chronic sun exposure, which potentially enhances skin photoaging over a lifetime.

BACKGROUND The distinct somatic mutations that define clinical and histopathological heterogeneity in cutaneous melanoma could be dependent on host susceptibility to exogenous factors like ultraviolet radiation. OBJECTIVES Firstly, to characterize patients with cutaneous melanoma clinically and pathologically based on the mutational status of BRAF, NRAS and TERT promoter. Secondly, to elucidate the modified features due to the presence of TERT promoter mutations over the background of either BRAF or NRAS mutations. METHODS We performed a retrospective study on 563 patients with melanoma by investigating somatic mutations in BRAF, NRAS and TERT promoter. RESULTS We observed co-occurrence of TERT promoter mutations with BRAF and NRAS mutations in 26.3% and 6.9% of melanomas, respectively. Multivariate analysis showed an independent association between BRAF mutations and a decreased presence of cutaneous lentigines at the melanoma site, and an increased association with the presence of any MC1R polymorphism. We also observed an independent association between TERT promoter mutations and increased tumour mitotic rate. Co-occurrence of BRAF and TERT promoter mutations was independently associated with occurrence of primary tumours at usually sun-exposed sites, lack of histological chronic sun damage in surrounding unaffected skin at the melanoma site, and increased tumour mitotic rate. Co-occurrence of NRAS and TERT promoter mutations was independently associated with increased tumour mitotic rate. The presence of TERT promoter together with BRAF or NRAS mutations was associated with statistically significantly worse survival. CONCLUSIONS The presence of TERT promoter mutations discriminates BRAF- and NRAS-mutated tumours and indicates a higher involvement of ultraviolet-induced damage and tumours with worse melanoma-specific survival than those without any mutation. These observations refine classification of patients with melanoma based on mutational status.

A group of melanomas characterised by predominant growth as large nests within the epidermis has been described. These cases present a diagnostic challenge, as many traditional architectural criteria for the recognition of melanoma are absent. We report the clinical, histological, immunohistochemical, morphometric and cytogenetic features of a series of 12 cases of large nested melanoma. In this series, large nested melanoma accounted for 0.2% of cases of melanoma. The majority occurred on the trunk of middle aged patients with absent or minimal solar elastosis and 42% were associated with a component of benign intradermal melanocytic naevus, speaking to classification of these melanomas as falling within the spectrum of lesions developing in skin with low cumulative sun damage. In 67% of cases invasive melanoma was present. Criteria such as asymmetry, variation in nest size and intraepidermal nests with an underlying rim of junctional keratinocytes appear to be highly specific, and are strongly predictive of typical cytogenetic abnormalities of melanoma, which were identified in 92% of cases. Conversely, in addition to features which are definitionally absent or limited, features such as solar elastosis and cytological atypia do not appear to be particularly helpful in recognition of this variant.

Sun exposure is the primary cause of skin cancer, and it has been suggested that most cases of melanoma could be prevented with greater understanding of sun damage and protection. Amy Noakes explains the vital role of sunscreen

Sun exposure is the primary cause of skin cancer, and it has been suggested that most cases of melanoma could be prevented with greater understanding of sun damage and protection. Amy Noakes explains the vital role of sunscreen

Acquired brachial cutaneous dyschromatosis (ABCD) is a relatively newly described, acquired disorder of pigmentation characterized by geographic-shaped, gray-brown, hyperpigmented patches and interspersed with hypopigmented macules, involving the dorsal aspects of the forearms in postmenopausal women. There is a suggested relationship with hypertension and antihypertensive medication intake, specifically angiotensin-converting enzyme inhibitors, or a cumulative effect of sun damage, as possible triggers. ABCD is benign, asymptomatic, and more of an esthetic concern. Topical depigmenting agents, chemical peels, and laser therapy may be helpful.

Concerns over existing sunscreen filters have reinforced the need to examine supplemental sun protection or repair of sun damage. Technology to enhance DNA repair has been available in skincare and sunscreen products for several decades, but skepticism and lack of familiarity with the supporting data remain prevalent. Here, we address six of the main questions raised by medical professionals regarding the efficacy of DNA repair enzymes in sun protection. These include the mode of delivery and mechanism of action, the effect on cellular responses and the amelioration of pre-cancers, cancers and photoaging. The conclusions are that topical DNA repair enzymes do enhance removal of DNA damage and reduce the appearance of new actinic keratoses as well as increase regression of existing lesions. Support for prevention of photoaging and skin cancer is significant but could be strengthened or disproven with additional research.

Phototoxicity (sunburn) and photosensitivity are the two most important forms of sunlight induced disease recognised by veterinary surgeons in the dog, cat and horse. Phototoxicity is mediated by UVB radiation and has a spectrum of presentations, ranging from sunburn to more severe actinic damage and squamous cell carcinoma. Phototoxicity is usually seen on white or non-pigmented skin, especially where there is little hair covering, and is recognised in all three species. Photosensitisation is most commonly seen in the horse and represents an abnormal reaction of the skin to light, caused by photodynamic agents in or on the skin. Sun avoidance and sun protection are important in all of the domestic species, to prevent sunlight induced disease.

Background Scalp reconstruction has evolved over time. Given the large surface area, location, and high likelihood of sun exposure, the scalp is particularly prone to sun damage and skin cancer. Resection of scalp cancers often leaves a large defect that can be challenging for reconstruction. The authors present objective data and recommendations based on more than 10 years of consecutive scalp reconstructions performed by the senior author (J.F.T.). In addition, the authors describe each method of reconstruction and delineate an algorithm based on the senior author's approach and the cases assessed. Methods The authors conducted a retrospective review of patients who underwent scalp reconstruction after Mohs cancer excision over a 10-year period. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications. Results The senior author (J.F.T.) performed 913 scalp reconstruction procedures. Defects most commonly involved the forehead or vertex of the scalp, with a wide range of sizes. A significant majority of the patients' defects were repaired with the use of adjacent tissue transfer or Integra dermal regeneration templates. There were 94 complications (12.5 percent) noted, ranging from graft loss to cancer recurrence. Conclusions Reconstruction of scalp defects after Mohs cancer excision presents the plastic surgeon with numerous patient and defect preoperative variables to consider. Each defect should be evaluated, and a plan based on composition of the defect and the needs of the patient should be developed. Scalp reconstruction is safe to perform in an outpatient setting, even in elderly patients. Clinical question/level of evidence Therapeutic, IV.

Background Chronic sun damage in the background is common in pigmented actinic keratoses and Bowen’s disease (pAK/BD). While explainable artificial intelligence (AI) demonstrated increased background attention for pAK/BD, humans frequently miss this clue in dermatoscopic images because they tend to focus on the lesion. Aim To analyse whether perilesional sun damage is a robust diagnostic clue for pAK/BD and if teaching this clue to dermatoscopy users improves their diagnostic accuracy. Methods We assessed the interrater agreement and the frequency of perilesional sun damage in 220 dermatoscopic images and conducted a reader study with 124 dermatoscopy users. The readers were randomly assigned to one of two online tutorials; one tutorial pointed to perilesional sun damage as a clue to pAK/BD (group A) the other did not (group B). In both groups, we compared the frequencies of correct diagnoses before and after receiving the tutorial. Results The frequency of perilesional sun damage was higher in pAK/BD than in other types of pigmented skin lesions and interrater agreement was good (kappa = 0.675). The diagnostic accuracy for pAK/BD improved in both groups of readers (group A: +16.1%, 95%‐CI: 9.5–22.7; group B: +13.1%; 95%‐CI: 7.1–19.0; P for both

Sunscreen application to UV-exposed skin is promoted to prevent skin cancer and sun damage, within a comprehensive photoprotection strategy that also includes sun avoidance and wearing UV protective clothing. The benefits of sunscreen are verified in preventing sunburn but appear to be largely presumptive in skin cancer prevention. Contemporary science establishes UVA as a primary driver of melanoma and photoaging. Consequentially, the traditional UVB-skewed protection of sunscreens provides an intellectual and logical explanation for rising skin cancer rates and, in particular, their failure to protect against melanoma. Better protection could be achieved with more balanced UVB/UVA sunscreens, toward spectral homeostasis protection. Greater balanced protection has another advantage of attenuating fewer UVB rays, which aid synthesis of vitamin D and nitric oxide. Percutaneous absorption of Soluble Organic UV Filters leads to systemic exposure, which becomes the relevant safety consideration. It is minimized by selecting Insoluble UV Filters with low absorption potential from a molecular weight above 500 Da. The filters must also be very hydrophilic, very lipophilic, or consist of particles. The risk-benefit ratio is a medical imperative, more so for cosmetics or sunscreens, since in principle there should be no risk from their use. The production of ideal sunscreens that mimic the effective, balanced UVB/UVA attenuation of textiles and shade is now possible, while maintaining an acceptable therapeutic margin of safety in humans and a favorable ecologic profile. Sunscreens with a favorable risk-benefit ratio and good esthetic properties or other consumer-friendly attributes will improve compliance and may achieve substantial clinical benefits.

Actinic keratoses (AKs) represent a premalignant skin condition due to chronic sun damage that dramatically increases in prevalence in the aging population. Currently, animal models of AKs utilize photocarcinogenesis, chemical carcinogens, or targeted gene modulation, and each method possesses unique strengths and weaknesses. Models using photodamage most comprehensively describe methods for preferentially selecting AK lesions, while replicating the pathogenesis of AKs with greater fidelity than models utilizing other carcinogenic methods. The following review of current murine models of AKs will aid in the selection of mouse models appropriate for future in vivo studies to test the efficacy of novel therapeutic agents for the treatment of AKs.

‘A picture is worth a thousand words’. While the concept of imaging the skin to understand its condition may seem obvious, used effectively it can be an extremely powerful tool for the researcher. We are used to observing the world with visible light, but changing our perspective and moving outside of that range to ultraviolet or infrared, or by using light produced as a result of fluorescence, can provide insights into skin condition impossible to view in other ways. These approaches present some challenges which are different to those experienced with traditional visible light imaging; however skin scientists and dermatologists can use the available techniques outlined in this chapter to examine and diagnose a wide range of skin conditions and pathologies, including sun damage, dry skin and atopic dermatitis, and bacterial and fungal infections.

Objective This study was aimed to examine patients’ knowledge, behaviours and attitudes regarding actinic keratosis (AK) lesions and the impact of the disease on patients’ quality of life (QoL). Methods Observational study of patients with AK lesions in Spain. QoL was evaluated with the validated version of Spanish AKQoL questionnaire. Skin self-examination, sun-exposure, habits and attitudes towards AK's treatment were recorded using different questionnaires. The adherence was assessed by means of the Morisky-Green test. Among other variables, QoL and adherence to treatment were compared by using Pearson's χ2 test and one-way ANOVA tests. Inferential analysis regarding such factors and length of treatment were also performed. Results A total of 1240 patients (73.6 [10.5] years old) were recruited. Overall, patients that showed higher levels of concern were also showed a higher impairment on QoL. AK had greater effects on women's QoL and those who performed skin self-examination, think that AK is a disease and/or believe that moisturizers can prevent skin aging (P Conclusions Concerns due to AK are mainly related to sex and to the consideration of AK as a disease. More concerned patients tend to have lower QoL and good adherence to treatment. Short length of treatment was associated with better adherence and complete remission of AK lesions.

Pear fruit are subject to sun damage from high fruit surface temperature (FST). Shade netting has been shown to decrease FST and sunburn damage of apples but also decreased fruit colour. The aim of this study was to investigate the effects of netting on FST, fruit sunburn and fruit colour of the red-blushed pear cultivar ‘ANP-0131’. FST was measured using fine-wire thermocouples inserted into 54 fruit in a netted block of trees and into 56 fruit in adjoining rows of non-netted trees. Netting reduced the maximum FST by 10%. FST under netting did not exceed the reported sunburn damage threshold of 47°C despite air temperature reaching 38.6°C. The maximum FST in the non-netted site regularly exceeded the sunburn damage threshold and reached a maximum of 50.3°C. Assessments of sunburn damage showed a clear decrease in sunburn (amount and severity) for fruit from the netted trees; however, netting negatively affected colour intensity and coverage.

Background: Sun exposure causes extensive intrinsic as well as extrinsic changes in the skin. Pathogenic effects of sun exposure such as tanning, melasma, skin cancer, and aggravation of various photodermatoses such as systemic lupus erythematosus (SLE) may be prevented by the use of sunscreens. We conducted the present study to assess the knowledge and attitudes regarding sun exposure and use of sunscreens. Methods: Two thousand and thirty-seven volunteers answered the questionnaire over a period of 2 years. All adults aged 18 years and above who voluntarily agreed to participate in the study after written informed consent were included. Results: Out of 2037 volunteers, 1242 volunteers had no knowledge of sunscreens. Sixty-eight percent of the volunteers from the upper class of society knew about sunscreens, and 86% of the volunteers from the lower middle class did not know about sunscreens. Eight-one percent of the volunteers did not suffer from sunburns. Eight-four percent of the volunteers were aware that sun exposure caused darkening, but awareness about other effects of sun exposure such as wrinkling, melasma, allergy, and photo-induced cancers was less. Most of the volunteers agreed that sunscreens protected against sun damage and tanning. Fifty-eight percent of the volunteers applied sunscreen before venturing out, and 78% of the volunteers applied sunscreen only on the face. Prevention of tanning was the most common reason for the usage of sunscreens. Cosmetic appeal and irritant potential were the prominent deciding factors in choosing sunscreens. Conclusion: Awareness about protective spectrum of sunscreens, their correct method of application, and misconceptions need to be focused on. Better product development keeping in mind the Indian conditions would help in increasing the usage of sunscreens.

RationaleUsing indoor tanning devices is associated with substantial health consequences, such as an increased risk of melanoma and other skin cancers. Many people including minors and some at high risk of skin cancer continue to use these devices. In the absence of effective restrictions on use, it is important that behaviour change interventions are designed to reduce indoor tanning.ObjectiveTo explore reasons for use of indoor tanning devices and the acceptability of alternatives in adult users residing in North-West England.MethodsParticipants were required to be current indoor tanners aged 18 years and above and were recruited online. Twenty-one participants took part in either a focus group or semi-structured interview. An inductive thematic analysis was conducted.ResultsSix themes were identified: psychological benefits; improving physical health; denial of health risks; alternatives do not meet psychological needs; alternatives do not meet physical needs; and perceived side-effects. Participants used indoor tanning devices to improve their self-esteem and to prevent sun damage to their skin (by gaining a ‘base tan’). Participants appeared to justify their usage by responding defensively to avoid accepting they were at risk, exaggerating the benefits of indoor tanning, and discounting alternatives to indoor tanning. Alternatives to indoor tanning were perceived as risky for health, inadequate to provide the desired aesthetic, and incapable of meeting their self-esteem needs.ConclusionsInterventions to reduce indoor tanning behaviour should increase sources of self-esteem other than appearance, increase media literacy and address defensive responses to information around indoor tanning and alternatives. Further research is needed to develop these interventions and assess their feasibility.

Dermoscopy is a non-invasive, in vivo technique that allows the visualization of subsurface skin structures in the epidermis, at the dermoepidermal junction, and in the upper dermis. Dermoscopy brought a new dimension in evaluating melanocytic skin neoplasms (MSN) also representing a link between clinical and pathologic examination of any MSN. However, histopathology remains the gold standard in diagnosing MSN. Dermoscopic–pathologic correlation enhances the level of quality of MSN diagnosis and increases the level of confidence of pathologists. Melanoma is one of the most genetically predisposed among all cancers in humans. The genetic landscape of melanoma has been described in the last years but is still a field in continuous evolution. Melanoma genetic markers play a role not only in melanoma susceptibility, initiation, and progression but also in prognosis and therapeutic decisions. Several studies described the dermoscopic specific criteria and predictors for melanoma and their histopathologic correlates, but only a few studies investigated the correlation among dermoscopy, pathology, and genetic of MSN. The aim of this work is to review the published data about dermoscopic features of melanoma, their histopathological correlates with regards also to genetic alterations. Particularly, this review will focus on low-CSD (cumulative sun damage) melanoma or superficial spreading melanoma, high-CSD melanoma, and nevus-associated melanoma.

Despite the chronic and increasingly prevalent nature of actinic keratosis (AK) and existing evidence supporting assessment of the entire cancerization field during clinical management, a standardized definition of the AK field to aid in the understanding and characterization of the disease is lacking. The objective of this review was to present and appraise the available evidence describing the AK cancerization field, with the aim of determining a precise definition of the AK field in terms of its molecular (including genetic and immunological), histological and clinical characteristics. Eight European dermatologists collaborated to conduct a review and expert appraisal of articles detailing the characteristics of the AK field. Articles published in English before August 2016 were identified using PubMed and independently selected for further assessment according to predefined preliminary inclusion and exclusion criteria. In addition, a retrospective audit of patients with AK was performed to define the AK field in clinical terms. A total of 32 review articles and 47 original research articles provided evidence of sun-induced molecular (including genetic and immunological) and histological skin changes in the sun-exposed area affected by AK. However, the available literature was deemed insufficient to inform a clinical definition of the AK field. During the retrospective audit, visible signs of sun damage in 40 patients with AK were assessed. Telangiectasia, atrophy and pigmentation disorders emerged as 'reliable or very reliable' indicators of AK field based on expert opinion, whereas 'sand paper' was deemed a 'moderately reliable' indicator. This literature review has revealed a significant gap of evidence to inform a clinical definition of the AK field. Therefore, the authors instead propose a clinical definition of field cancerization based on the identification of visible signs of sun damage that are reliable indicators of field cancerization based on expert opinion.

Actinic keratosis (AK) lesions are surrounded by field cancerization (areas of subclinical, non-visible sun damage). Existing AK grading tools rely on AK counts, which are not reproducible. An Actinic Keratosis Field Assessment Scale (AK-FAS) for grading the severity of AK/field was developed. Standardized photographs of patients representing the full range of AK severity were collected. Six investigators independently rated each photograph according to 3 criteria: AK area (total skin area affected by AK lesions), hyperkeratosis and sun damage. Inter-rater reproducibility was good for all 3 criteria. Validation of the AK-FAS showed good reproducibility for AK area and hyperkeratosis, even for dermatologists untrained on use of the scale. In conclusion, the AK-FAS is objective, easy to use and implement, and reproducible. It incorporates assessment of the entire field affected by AK instead of relying on lesion counts. Use of the AK-FAS may standardize AK diagnosis, making it relevant to routine clinical practice.

Extensive promotion on the internet and in the media has led to an increase in public awareness that too much exposure to sun can cause photodamage and skin cancers. However, there are gaps in knowledge regarding the selection of the right sunscreen, recommended dose and daily application schedule. The labels of sunscreens are often difficult to understand and consumers remain unaware about the potential photodamage caused by infrared (IR) and high-energy visible light (HEVL). Patients are becoming increasingly conscious about skin health and aesthetics, but they often seek help only after a significant amount of sun damage has already occurred. There are still many discrepancies related to the correct method of sunscreen application and the best times for reapplication. Much more research is needed to study the harmful effects of sunscreen ingredients on systemic absorption, if any, in areas such as safety in pregnant and breastfeeding women, and the relationship to various skin cancers and diseases. This article discusses the types and formulations of sunscreens for ultraviolet light, IR and HEVL protection. It also covers sunscreen labels, application techniques, recommended doses, safety and possible health hazards, related controversies, product shelf life and the importance of patient education.

Despite the increasing prevalence of social media usage in health care contexts, its impact on skin cancer prevention and awareness has not been largely investigated. We conducted a review of literature on this topic with the objective of summarizing and analyzing the role of social media in skin cancer and sun damage awareness and to identify the uses, benefits, and limitations of different social media platforms on skin cancer prevention. In today’s technological society, it is critical to understand and study the best form of communication. Specific platforms like Instagram, Twitter, Facebook, YouTube, and TikTok vary in originators of material, target demographics, messaging strategies, and reliability of information with regards to skin cancer, sun, and indoor tanning damage. Our results demonstrate that social media interventions have shown promise in skin cancer prevention and continue to escalate by the day. Dermatologists should keep pace with the latest dermatological content on social media and examine its evolution to target the right audience with the proper messages. Further research is needed to evaluate the effectiveness and true impact of social media on meaningful and lasting behavior change for skin cancer prevention.

Background Sunscreens are known to protect from sun damage; however, their effects on the reversal of photodamage have been minimally investigated. Objective The aim of the prospective study was to evaluate the efficacy of a facial sun protection factor (SPF) 30 formulation for the improvement of photodamage during a 1-year use. Methods Thirty-two subjects applied a broad spectrum photostable sunscreen (SPF 30) for 52 weeks to the entire face. Assessments were conducted through dermatologist evaluations and subjects' self-assessment at baseline and then at Weeks 12, 24, 36, and 52. Results Clinical evaluations showed that all photoaging parameters improved significantly from baseline as early as Week 12 and the amelioration continued until Week 52. Skin texture, clarity, and mottled and discrete pigmentation were the most improved parameters by the end of the study (40% to 52% improvement from baseline), with 100% of subjects showing improvement in skin clarity and texture. Conclusion The daily use of a facial broad-spectrum photostable sunscreen may visibly reverse the signs of existing photodamage, in addition to preventing additional sun damage.

Sun-injury (=sunburn) on apples is an important physiological disorder affecting all cultivars grown in semi-arid climates. Both, high light and elevated temperatures during the fruit-growing season are responsible for the symptoms. Therefore, a crop water stress index (CWSI), calculated from infrared images, and chlorophyll fluorescence were assessed as early predictors, when no symptoms of sun-damage were yet visible. Fifty fruit of each cv. (Royal Gala, Granny Smith, Fuji) were tagged at 50 days after full bloom (DAFB) in different orchards. Infrared images were taken weekly and used for CWSI calculation. A similar number of fruit (Royal Gala, Fuji) were tagged after 80 DAFB for chlorophyll fluorescence measurements carried out every 2 weeks. The proposed CWSI was able to predict the occurrence of severe sunburn symptoms in Granny Smith apples as early as 86 DAFB, 42 days before symptoms were visible. In Fuji, this occurred as early as 122 DAFB, 25 days prior visible symptoms. The threshold value of CWSI required for sunburn development on the fruit was 0.5. The maximum quantum efficiency of photosystem II (Fv/Fm) was also able to detect early sun damage, at 100 DAFB, before symptoms appearance, with a threshold value of 0.6. The results would imply that early events in photooxidative stress leading to sun injury have a profound effect on tissue physiology and biochemistry, which can be assessed using chlorophyll fluorescence and a thermography-based index, such as the CWSI. Both, the CWSI and Fv/Fm ratio could be used as non-destructive, fast and reliably field tools to monitor sun-injury when no symptoms have yet developed.

Chronic erosive pustular dermatitis with a predilection for the scalp is a hallmark of ectodermal dysplasias (EDs) caused by mutations in TP63, including Rapp-Hodgkin and Hay-Wells EDs. It is among the most troublesome and symptomatic complications and is typically refractory to classic wound care approaches. We report two cases of Rapp-Hodgkin ED with refractory scalp erosions that markedly improved with the use of potent topical steroids. We also note marked similarities between this scalp inflammation and "erosive pustular dermatosis of the scalp," a condition more typically found in elderly individuals with severe scalp sun damage, and speculate about possible shared pathogenetic mechanisms.

Climate change negatively influences many human activities and one of the most affected is agriculture. In the apple industry, water availability, elevated temperatures and altered phenology will transform fruit production in traditional growing regions. Extended periods of intense solar radiation and high temperatures during the growing season cause problems in fruit quality increasing losses and reducing sustainability and profitability. Photooxidative and heat stress stimulate sunburn development on apple fruit in the field growing under increasingly stressful conditions. In particular, apples growing in semi-arid conditions are frequently exposed to high solar irradiance and elevated temperature during the growing season that promote the development of sun-related skin disorders. Furthermore, regions that have traditionally not faced sunburn pressure may begin to experience losses in this area. Apple cultivars differ in their susceptibility to sun damage, which is evidenced, in part, by the timing of symptom development and severity. Some studies attribute genotypic variation to physiological and morphological differences while others do to antioxidant-related metabolic differences between them. Here, we discuss the physiological and molecular progress and gaps in knowledge of sunburn damage and the development of sunburn resistance in apple fruit. This information will help develop stronger sunburn mitigation strategies and enhance breeding efforts to address challenges associated with sunburn in apple production.

This study estimated minimum air temperatures for potential sun damage for sunburn browning (non-netted and netted) and sunburn necrosis (non-netted) for Royal Gala apple in Australia. The approach estimated when conditions may be conducive to the development of sun damage in some fruit. The approach provides a measure of potential damage. This allows for more flexible analyses of potential sun damage which current models are unable to produce due to data limitations. The air temperature thresholds determined were 34.1 and 38.7 °C, respectively, for browning and necrosis for non-netted fruit and 37.9 °C for browning under netting. These air temperature thresholds were applied across southern Australia from 1911–2013 demonstrating different risk profiles between sites, inter-annual variability and the benefit of installing netting via a reduction in potential damage days. The results can be further extended to estimate impacts from climate change and assess the benefit of installing netting to adapt to inc...

Previous studies on the association of solar lentigines with ultraviolet radiation (UVR) exposure have been based on retrospective questionnaires about UVR exposure. We aimed to investigate the association between solar lentigines and UVR exposure in healthy individuals using objective measurements, and to investigate the association between solar lentigines and cutaneous malignant melanoma (CMM). Forty-eight patients with CMM and 48 controls that matched the patients individually by age, sex, constitutive skin type and occupation participated. Solar lentigines on the shoulders and upper back were counted and graded into 3 categories using black light photographs to show sun damage. Current UVR exposure in healthy controls was assessed by personal electronic UVR dosimeters that measured time-related UVR and by corresponding exposure diaries during a summer season. Sunburn history was assessed by interviews. Among controls, the number of solar lentigines was positively associated with daily hours spent outdoors between noon and 3 pm on holidays (P = 0.027), days at the beach (P = 0.048) and reported number of life sunburns (P < 0.001). Compared with matched controls CMM patients had a higher number of solar lentigines (P = 0.044). There was a positive association between CMM and higher solar lentigines grade; Category III versus Category I (P = 0.002) and Category II versus Category I (P = 0.014). Our findings indicate that solar lentigines in healthy individuals are associated with number of life sunburns, as well as time spent outdoors around noon on holidays and beach trips during a summer season, most likely reflecting past UVR exposure, and that solar lentigines are a risk factor for CMM.

Fig 1. Hypertrophic lupus erythematosus. A, Clinical image of extensive verrucous plaques on the right postauricular area, pinna, and cheek. B, Discoid lesion on the left cheek, demonstrating a scaly peripheral edge and central whitish-pink atrophic area. C, Polarized contact dermoscopic view of the scaly anterior edge of the discoid plaque pictured in (B) showing numerous white-to-yellow hyperkeratotic follicles, confluent scaly areas, whitish perifollicular haloes, blurred reddish vascular areas (arrows), and linear vessels. D, Central atrophic area of the same lesion revealing homogeneous white-to-pinkish areas with dotted (circle), hairpin (rectangle), and linear vessels (arrow). The dermoscopic features depicted in (C) suggest active DLE, whereas the features in (D) are consistent with advanced DLE.

Most skin cancers, which are among the most common malignancies in the UK, follow excessive exposure to ultraviolet (UV) radiation and are, therefore, potentially preventable. In general, most people receive much of their lifetime UV exposure as children and adolescents, and sun damage during childhood markedly increases the risk of developing skin cancer in later life. This article considers elements that nurses could include in their school's safe sun policies and when educating pupils, parents and staff. In addition, school nurses could encourage the curriculum and timetable to consider sun protection and inform architectural discussions. Sunlight is, however, the main source of vitamin D in the UK. People who avoid all sun exposure should consider having their serum vitamin D measured. If levels are reduced or deficient, nurses could consider suggesting increasing vitamin D intake.

// Alejandro Martin-Gorgojo 1, * , Marta Llinares 2, * , Amaya Viros 3, 4, * , Celia Requena 2 , Zaida Garcia-Casado 5 , Victor Traves 6 , Rajiv Kumar 7 and Eduardo Nagore 2, 8 1 Escuela de Doctorado, Universidad Catolica de Valencia “San Vicente Martir”, Valencia, Spain 2 Department of Dermatology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain 3 Skin Cancer and Ageing Laboratory, CRUK Manchester Institute, Manchester, UK 4 Salford Royal NHS Foundation Trust, Manchester, UK 5 Department of Molecular Biology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain 6 Department of Pathology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain 7 Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany 8 Dermatology Department, School of Medicine, Universidad Catolica de Valencia “San Vicente Martir”, Valencia, Spain * These authors have contributed equally to this work Correspondence to: Eduardo Nagore, email: eduardo_nagore@ono.com Keywords: melanoma; nevus; risk; sunburn; solar elastosis Received: July 20, 2017 Accepted: September 23, 2017 Published: October 24, 2017 ABSTRACT There are at least two pathways driving cutaneous melanoma; one is linked to an inherent melanoma susceptibility to nevi development and the second to environmental cumulative ultraviolet light exposure. In this study, we examined the relation between nevus density, accrued sun damage and the site of primary melanoma excision. In a series of 888 consecutive cutaneous melanoma patients, melanomas appearing in skin areas with a high relative nevus density were most prominent in men, with an elevated nevus count, at sites without solar elastosis, but with an epidemiological history of previous sunburn. The present study associates melanoma development to sites with high nevus density. Our study supports more careful surveillance of body areas with increased nevus density in patients with high total body number of nevi, especially when they report a history of sunburns at these sites.

High doses of oral vitamin D 3 attenuate skin inflammation following experimentally induced sun damage.

not present

Summary The aim of this study was to determine the frequency of Merkel cell Polyomavirus (MPyV) and p63 positivity by immu-nohistochemistry in a large cohort of primary Merkel cell carcinoma (MCC) from a region with high rates of actinic damage. We also aimed to determine whether there is any relationship between these markers and histological correlates of chronic sun exposure and to identify whether these markers have prognostic significance in our population. Ninety-five cases of primary cutaneous MCC were identified and stained with immunohistochemical markers for MPyV and p63. The presence of solar elastosis and squamous dysplasia in the overlying/adjacent skin were recorded as markers of actinic damage. Follow up data were obtained from the Western Australian Cancer Registry. MPyV was detected by immunohistochemistry in 23% of cases. There was a statistically significantly lower rate of positivity in tumours associated with markers of chronic sun damage as assessed by the presence of solar elastosis and squamous dysplasia. There was no association with overall or disease specific survival. p63 positivity was detected in 17% of cases. There was no association with markers of actinic damage or with overall or disease specific survival. Our data demonstrate a significant difference in rates of immunohistochemical positivity for MPyV between MCC in sun-damaged and non-sun-damaged sites. This may go some way to explaining previously identified geographical differences. When compared with a number of studies from Europe and North America, p63 positivity is less common in our population and does not show the strong prognostic significance that has been found in these other regions.

Periungual basal cell carcinoma is rare and needs to be differentiated from other common diseases that affect this region. Several factors are associated with the development of this tumor, and sun damage seems to play an important role in its pathogenesis. Dermoscopy of clinically indolent lesions on the nail unit can shorten the diagnostic process and avoid destructive treatment and functional damage.

Children and adolescents may be vulnerable to increased ultraviolet radiation exposure and greater risk for subsequent sun-related pathologies. This study examined the demographic, geographic, and phenotypic factors influencing sun exposure and protective behaviors among children and adolescents living in the United States. A cross-sectional survey on perceived sun exposure and protective behaviors was administered at three sports medicine clinics in California, Colorado, and Hawaii. Responses were measured with a 5-item frequency scale: Never, Rarely (25% of the time or less), Sometimes (50% of the time), Often (75% of the time or more), and Always. Sun protective behavior was examined using univariate and multivariate analyses. In total, 860 surveys were collected (52% female, 48% male; mean age 12.7 years). Females reported significantly greater frequency of using sunscreen (p = 0.001), staying in the shade or using an umbrella while in the sun (p = 0.004), and tanning (p

A variety of pathologic variants of cutaneous squamous cell carcinoma (SCC) has been reported, and the signet-ring variant of cutaneous SCC is extremely uncommon. We reported an 83-year-old man with signet-ring SCC arising on the back of the finger. As far as we know, only 4 cases have been described in detail, and one dermatopathologic report focused on the presence of signet-ring cells briefly described in clinical data of 6 cases. Interestingly, in these reports, the skin lesions of 10 cases occurred exclusively in the head and neck area. This case involved a skin lesion on the back of the finger and is thus the first reported case of signet-cell cutaneous SCC that did not arise in the head and neck area. The location of this lesion, together with the histological findings compatible with actinic keratosis, support the hypothesis that the development of signet-ring SCC is related to ultraviolet light-induced damage.

It is estimated that total sun exposure occurs non-intentionally in three quarters of our lifetimes. Our skin is exposed to majority of UV radiation during outdoor activities, e.g. walking, practicing sports, running, hiking, etc. and not when we are intentionally exposed to the sun on the beach. We rarely use sunscreens during those activities, or at least not as much and as regular as we should and are commonly prone to acute and chronic sun damage of the skin. The only protection of our skin is endogenous (synthesis of melanin and enzymatic antioxidants) and exogenous (antioxidants, which we consume from the food, like vitamins A, C, E, etc.). UV-induced photoaging of the skin becomes clinically evident with age, when endogenous antioxidative mechanisms and repair processes are not effective any more and actinic damage to the skin prevails. At this point it would be reasonable to ingest additional antioxidants and/or to apply them on the skin in topical preparations. We review endogenous and exogenous skin protection with antioxidants.

Pear fruit are subject to sun damage from high fruit surface temperature (FST). Threshold FST for the occurrence of sunburn are currently unknown and basic relationships between FST of pears and weather parameters have not been reported. Such knowledge is needed to aid implementation of management practices and improve orchard design to minimise sunburn. This paper reports relationships between pear FST and weather conditions. Continuous monitoring of FST and observations of sunburn damage enabled determination of threshold FST for the development of sunburn. Threshold FST for sunburn damage on ‘ANP-0131’ (Deliza®) pears was estimated to be 47.1 °C. Use of FST thresholds to improve mitigation of sunburn is discussed.

This study aimed to determine whether a broad-spectrum liposomal sunscreen with a very high sun protection factor (Daylong actinica) can prevent damage induced by ultraviolet (UV) irradiation in patients with cutaneous lupus erythematosus (CLE) and healthy controls (HCs) under standardised conditions. In 20 patients with CLE and 10 HCs, defined areas of sunscreen-untreated and sunscreen-treated skin on the upper back were irradiated with combined UVA/UVB light. Disease-specific skin lesions were induced by UVA/UVB light in the untreated areas of nine patients with CLE; no specific eruptions or any sun damage was observed in the sunscreen-treated areas in any of the CLE patients, nor in the HCs. Histological analysis of skin biopsy specimens confirmed the clinical results. In conclusion, the use of a high-protection, broad-spectrum sunscreen can prevent UV-induced damage in patients with CLE and HCs.

Solid organ transplant recipients (SOTRs) have an increased risk of skin cancer due to their long-term immunosuppressed state. These patients should benefit from pre- and post-transplant screening and management of skin cancer by a dermatologist. The frequency of the dermatological consultations mainly depends on the previous history of skin cancer and this will be discussed in detail. In addition to cancer screening and management, dermatological consultations serve to educate and enforce patients’ sun-protective behavior. Indeed, SOTRs are very sensitive to sun damage due to their immunosuppressed state, leading to cumulative sun damage and numerous in situ epithelial lesions termed ‘field cancerization’, which are large areas with increased carcinogenesis. Lesions should be recognized and treated as early as possible using therapeutic options ranging from topical therapy and surgical management to the adjustment of the patient’s immunosuppressive therapy and chemoprevention. Therefore, dermatological f...

Background: Skin cancer is common in North America. Incidence rate trends are potentially important in the assessment of the effects of measures to increase sun awareness in the population as well as measures to reduce sun damage. Objective: To determine the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and cutaneous malignant melanoma (CMM) in a geographically defined Canadian population over a 40-year period. Methods: Data were obtained from the BC Cancer Registry for the calendar years 1973, 1983, 1993, and 2003. Results: Age-standardized incidence rates increased significantly from 1973 to 2003 for BCC, SCC, and CMM. Limitations: The ethnic makeup of British Columbia has changed over time, and a novel method of accounting for the effect of this on skin cancer rates is presented. Conclusion: The incidence rate for skin cancers continued to rise in British Columbia, but there appears to have been a decline in the incidence of CMM and BCC in the youngest cohorts.

BACKGROUND: Effective solar protection is an uncommon practice among young people, increasing the likelihood of sunburn, sunstroke and skin cancers. This fact is more significant in the south of Brazil, where the prevalence of white skinned population is larger, being more prone to sun damage. OBJECTIVES: To study the practices of sun exposure and sun protection in high school students from the city of Carlos Barbosa - RS. METHODS: Cross-sectional study involving 775 students, enrolled on the first half of 2010, who had signed the consent form. We used a non-identifiable, self-administered questionnaire, with questions about related topics. Statistical analysis was performed using Chi-square or Fisher exact and t-Student tests. The study was approved by the Research Ethics Committee under the number 2010-115H. RESULTS: Most students are exposed to the sun at the more critical periods, remaining exposed for more than an hour. Five hundred and seventy-six students (74,3%) reported using sunscreen, but less than 10% did it during all months of the year. Female teenagers are most likely to use sunscreen (p

Background Solar maculopathy is most commonly diagnosed after the direct viewing of solar eclipses. The damage to the retina is located in the outer segments of photoreceptors and in the retinal pigmentary epithelium. It may be acceptable to use optical coherence tomography (OCT) to identify retinal damage caused by the sun. Case report Here we describe a case of a patient who reported with a mild decrease in best-corrected visual acuities. Dilated examination found macular changes that were present in both eyes resembling solar maculopathy. OCT was utilized to aid in the diagnosis of solar maculopathy. Conclusions With the large number of individuals who spend their time in the sun, a practitioner should consider the possible repercussions of this activity. We are all aware of the damage that the sun can cause to the skin and, as in the case of cataracts, its effects on the eye. In cases in which macular changes are noted we should consider the possibility of solar maculopathy. As is in the case presented here, OCT may be an effective means of assessing the maculopathy.

Actinic keratoses are areas of intraepithelial neoplasia for which treatment is necessary. Because they arise in areas of sun damage, it is desirable to treat the entire damaged field to not only treat visible lesions, but also subclinical, emerging malignancies, ie, “field therapy”, 5-fluorouracil, imiquimod, and diclofenac are all treatment options, and are discussed and compared.

Background The density of melanocytes varies by anatomic site and degree of sun damage. Objective To determine the density of melanocytes and frequency of confluence in specimens adjacent to nonmelanoma skin cancers. Methods Two hundred final layer specimens from Mohs surgery for basal cell carcinomas were analyzed by using MART-1. Results Data for 162 skin specimens from the head demonstrated an average keratinocyte to melanocyte ratio of 7.12 and 8.19 for epidermis and adnexal structures, respectively. The 23 specimens from the trunk demonstrated respective ratios of 7.54 and 7.46, and 13 specimens from extremities demonstrated ratios of 8.69 and 12.38. Limitations Margins from Mohs micrographic surgery for nonmelanoma skin cancers were utilized as a proxy for chronically sun-damaged skin. Conclusion Our results suggest that chronically sun-exposed skin demonstrates increased melanocytic density, but confluence of melanocytes is rare. Occasionally intraepidermal pagetoid scatter and isolated melanocytic nests were rarely noted. These findings alone should not support an unequivocal diagnosis of melanoma in situ.

Dermatologists see many patients interested in improving their physical appearance through cosmetic procedures or medical means. Dermatologists frequently counsel patients on sun protection as well, particularly those with a personal or family history of skin cancer, sun-sensitive dermatoses or those with obvious sun damage. Our objective in this study was to identify novel markers of skin cancer risk which may aid dermatologists in targeting extra sun protection counseling for certain groups. A sixteen-question survey was distributed to subjects nineteen years of age and older in public areas of downtown Birmingham, Alabama in August and September of 2008. Overall, about 40% of both genders reported that they were highly concerned that current sun exposure could cause skin cancer. Participants interested in at least one appearance-related questionnaire item were significantly more likely than those not interested to rate tanned skin as highly important (31.6% vs 17.5%, p