Evaluation and management of nonmelanoma skin cancer. The military perspective

As the incidence of melanoma skin cancer continues to increase in this country, so does the need for early detection and treatment of these tumors. This article discusses a military skin cancer screening clinic that encourages patient participation and the criteria and statistics regarding the different treatment modalities we employ to treat these skin cancers.     

Immune response associated with nonmelanoma skin cancer

The effect of antioxidants and reducing agents on glutamate-induced cytotoxicity was examined using PC12 cells. The antioxidants vitamin E, idebenone, and selegiline protected cells against the cytotoxicity observed 24 h after exposure to 0.5 or 10 mM glutamate, as determined by lactate dehydrogenase leakage, even when added 3 h after glutamate. The reducing agents, glutathione (GSH) and dithiothreitol (DTT), also provided protection against the cytotoxicity of glutamate. Preincubation of PC12 cells with the antioxidants mentioned above, or the incubation with those antioxidants after exposure to glutamate for 3 h, prevented the reduction of viability caused by glutamate. Cystine uptake was inhibited by exposure of cells to glutamate, as determined by L-[35S]-cystine uptake. Incubation of cells with 0.5 or 10 mM glutamate caused a marked decrease in cellular GSH levels, not prevented by antioxidants. The activity of GSSG reductase was decreased by glutamate and this inhibition was reverted in the presence of the reducing agents GSH and DTT. These results indicate that glutamate toxicity on PC12 cells results from the inhibition of cystine uptake with consequent GSH depletion and oxidative stress, suggesting that antioxidants may reduce the cellular damage in pathologic conditions associated with excessive glutamate release.     

Increased cancer mortality following a history of nonmelanoma skin cancer

CONTEXT: Cancer registries have reported an increased incidence of melanoma and certain noncutaneous cancers following nonmelanoma skin cancer (NMSC). Whether these findings were attributable to intensified surveillance, shared risk factors, or increased cancer susceptibility remains unclear. OBJECTIVE: To determine whether a history of NMSC predicts cancer mortality. DESIGN: Prospective cohort with 12-year mortality follow-up adjusted for multiple risk factors. SETTING: Cancer Prevention Study II, United States and Puerto Rico. PARTICIPANTS: Nearly 1.1 million adult volunteers who completed a baseline questionnaire in 1982. MAIN OUTCOME MEASURE: Deaths due to all cancers and common cancers. RESULTS: After adjusting for age, race, education, smoking, obesity, alcohol use, and other conventional risk factors, a baseline history of NMSC was associated with increased total cancer mortality (men's relative risk [RR], 1.30; 95% confidence interval [CI], 1.23-1.36; women's RR, 1.26; 95% CI, 1.17-1.35). Exclusion of deaths due to melanoma reduced these RRs only slightly. Mortality was increased for the following cancers: melanoma (RR, 3.36 in men, 3.52 in women); pharynx (RR, 2.77 in men, 2.81 in women); lung (RR, 1.37 in men, 1.46 in women); non-Hodgkin lymphoma (RR, 1.32 in men, 1.50 in women); in men only, salivary glands (RR, 2.96), prostate (RR, 1.28), testis (RR, 12.7), urinary bladder (RR, 1.41), and leukemia (RR, 1.37); and in women only, breast (RR, 1.34). All-cause mortality was slightly increased (adjusted men's RR, 1.03 [95% CI, 1.00-1.06]; women's RR, 1.04 [95% CI, 1.00-1.09]). CONCLUSIONS: Persons with a history of NMSC are at increased risk of cancer mortality. Although the biological mechanisms are unknown, a history of NMSC should increase the clinician's alertness for certain noncutaneous cancers as well as melanoma.     

Oral psoralen and ultraviolet-A light (PUVA) treatment of psoriasis and persistent risk of nonmelanoma skin cancer. PUVA Follow-up Study

BACKGROUND/METHODS: The treatment of psoriasis with high-dose exposure to oral psoralen and ultraviolet-A light (i.e., PUVA) substantially increases the risk of cutaneous squamous cell cancer, but not of basal cell cancer, within a decade of beginning treatment. To assess the persistence of cancer risk among individuals treated with PUVA, including those who discontinued therapy long ago and those without substantial exposure to other carcinogens, we prospectively studied a cohort of 1380 patients with psoriasis who were first treated during the period from January 1, 1975, through October 1, 1976, and evaluated risk factors associated with the development of cutaneous squamous cell cancers and basal cell cancers after 1985. RESULTS: From 1975 through 1996, 237 patients developed 1422 cutaneous squamous cell cancers. From 1986 through 1996, 135 (12.5%) of 1081 patients without a prior squamous cell cancer developed 593 such tumors. From 1975 through 1997, 247 patients developed 1042 basal cell cancers; these patients included 151 individuals with a first basal cell cancer after 1985. Among those without a squamous cell or a basal cell cancer in the first decade of the prospective study, a strong dose-related increase in the risk of squamous cell cancer was observed in the subsequent decade (adjusted relative risk [> or =337 treatments versus <100 treatments] = 8.6; 95% confidence interval = 4.9-15.2). Risk of basal cell cancer was substantially increased only in those patients exposed to very high levels of PUVA (> or =337 treatments). CONCLUSIONS: High-dose exposure to PUVA is associated with a persistent, dose-related increase in the risk of squamous cell cancer, even among patients lacking substantial exposure to other carcinogens and among patients without substantial recent exposure to PUVA. Exposure to PUVA has far less effect on the risk of basal cell cancer. The use of PUVA for psoriasis should be weighed against the increased cancer risk.     

Prevention of malignant skin tumors

Sunlight is undoubtedly one of the main reasons of premature aging of the skin. UVB rays as well as UVA rays cause skin damage; therefore, suntan products should contain both UVB and UVA filters and pigments providing high sunray protection. Modern suntan preparations offer the appropriate base for every skin type. Loss of hydration has to be offset. As a consequence, cosmetical suntan lotions not only protect against sunrays, but also must moisturize the skin and care for it.     

Prevention of marital dysfunction: behavioral approaches and beyond

Marital dysfunction is a significant problem in the U.S., with far-ranging effects on the mental health, physical health, and economic well-being of people who experience it. In addition, marital discord and divorce appear to have adverse effects on children. This review describes the historical roots of current prevention programs and critically reviews marriage preparation programs that have been examined in the peer-reviewed literature. The results of 13 studies suggest that behaviorally oriented, skills-based marriage preparation programs can lead to behavioral changes that may help prevent the emergence of marital dysfunction. Whereas there has been modest improvement in the methodology of the program evaluations, suggestions for continued improvements are made. Ways to enhance the effectiveness of marriage preparation programs using the principles of prevention are described.     

Heidegger's investigative method in Being and Time.

[Correction Notice: An erratum for this article was reported in Vol 23(4) of Psychoanalytic Psychology (see record 2006-20697-002). The sentence on p. 599 should read as follows: "Heidegger makes crystal clear that by Being-in he does not mean a categorial relationship in which one present-at-hand entity is spatially contained inside another present-at-hand entity."] This article explores Heidegger's investigative method--which the author sees as a unique blending of phenomenology, hermeneutics, and contextualism--and its relationship to its subject matter, the meaning of Being. The unity of Heidegger's investigative method and its subject matter is seen to mirror the contextual whole whose basic structure as Being-in-the-world his investigation unveils. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Single-case investigative research and its relevance for the nonoperant clinician.

Asserts that a new research approach is needed to intra-S investigations that deals as seriously with actual clinical goals as it does with experimental design criteria. It is contended that the work of M. B. Shapiro published from 1951 to 1979 offers the nonoperant clinician a patient-oriented approach to evaluate the efficacy of clinical treatment. Four of his methodological principles of single-case research are presented. A new therapy process structure, the stage process model, which is compatible with Shapiro's patient-oriented approach, is presented. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oral contraceptive pills. Prevention of ovarian cancer and other benefits

Each year, about 25,000 new cases of ovarian cancer are diagnosed in the US. Because ovarian cancer has few symptoms in its early stages and there is no effective screening test, most patients have widespread metastases at diagnosis. Epidemiologic studies have demonstrated that OC use can protect against ovarian cancer for at least 15 years after pill use is discontinued. The most likely mechanism of this protective effect is inhibition of ovulation. A strong association between total number of lifetime ovulations and mutation of the p53 gene in ovarian cancers has been reported. Use of the pill for 5 years decreases the risk of ovarian cancer by 40% but decreases lifetime ovulations by only about 15%, suggesting that factors other than prevention of proliferation-associated mutations contribute to the protective effect of ovulation inhibition. The pill also decreases the incidence of endometrial cancer by about 50%. At present, OCs represent the best option for US women from both the contraceptive and cancer prevention perspectives.     

Mohs' chemosurgery and skin cancer

Experience in treating 1, 275 skin cancers with Mohs' chemosurgery is presented. The Mohs technic uses microscopic examination to avoid excision of normal tissue and assure complete removal of the tumor. Chemosurgery is indicated for tumors which are poorly demarcated or which arise in areas known to have a high recurrence rate. It is the procedure of choice for almost all recurrent lesions.     

Prevention of liver cancer

Hepatocellular carcinoma (HCC) is among the most prevalent and deadly cancers worldwide. Elevated incidence of HCC is strongly associated with hepatitis B virus infection and dietary exposure to hepatotoxic contaminants. Vaccination programs against viral hepatitis hold hope for the eventual reduction of HCC incidence, and screening of cirrhotic patients may provide one mechanism for improving prognosis of HCC patients. Additional efforts have focused on preventing or retarding liver cancer development in populations at risk for HCC mortality. This review highlights recent clinical trials aimed at exploring the efficacy and practicality of chemoprevention efforts in these cohorts. Preclinical findings that provide insight into mechanisms of hepatocarcinogenesis and point to potential strategies for intervention also are discussed. Finally, novel molecular mechanisms contributing to the known ability of chemopreventive agents to inhibit liver cancer in experimental models are explored.     

Mediation of a middle school skin cancer prevention program.

This study tested potential mediators of a school-based skin cancer prevention intervention for middle school children (6th-8th grades; N = 1,788). Ten variables were tested on 4 criteria to establish mediation, including (a) intervention related to outcome, (b) intervention related to mediators, (c) mediators related to outcome, and (d) mediated effect statistically significant. Sun-safe behaviors (e.g., sunscreen use) and potential mediators were measured with a self-report questionnaire. All criteria were met for Barriers--Sunscreen, Perceived Self-Efficacy, and Knowledge when the mediators were tested separately. In multiple mediator analyses, barriers to sunscreen use and self-efficacy satisfied Criteria 1-3 but were not statistically significant (Criterion 4). Barriers to sunscreen use, perceived self-efficacy for sun-safe behavior, and knowledge may serve as mediators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention and screening for breast cancer

Breast cancer is the most common cancer among women in both Europe and the U.S. It is the second leading cause of cancer deaths for women in the U.S., but the first in Poland. Age, family history, reproductive factors, proliferative breast disease, and radiation are established risk factors. Diet may account for differences in international incidence rates; however, the majority of women who get breast cancer do not have identifiable risk factors other than age and being female. Primary prevention of breast cancer is unknown. Control relies on secondary prevention aimed at suppression of clinically occult disease, mammographic screening, and early detection of palpable disease through physical examination and breast self-examination. Dietary and medical prevention strategies are being tested in the U.S. Screening mammography has demonstrated effectiveness in reducing mortality in women over 50. The "Partnerships in Healthcare" program aims to enhance the early detection of breast cancer in Poland by providing mammography units, training for technicians and nurses, and incentives to develop multidisciplinary approaches to diagnosis and treatment.     

Changing knowledge and attitudes about skin cancer risk factors in adolescents.

Examined knowledge, attitudes, and behaviors related to skin cancer (SC), sun exposure, sunscreen use, and use of tanning booths in 903 female and 800 male adolescents. The effectiveness of a brief, school-based intervention designed to increase teens' knowledge and preventive attitudes about SC was also evaluated. Females, older students, and those with high-risk skin types were most likely to use sunscreen and to take precautions. However, overall level of protection was low. Intentions to take precautions were associated with levels of perceived susceptibility to SC, attitudes about the benefits of sun exposure, skin type, and sex. Beyond intentions, sunscreen use was associated with perceived susceptibility and skin type. The 1-session, school-based intervention significantly increased knowledge of and perceived susceptibility to SC but not behavioral intentions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The enhancement of memory by hypnosis in the legal investigative situation.

The increasing use of hypnosis on North America to enhance or refresh the memories of victims and witnesses of crime is creating concern, both within the professional hypnosis societies and within the legal profession. The authors review current positions on the issue and survey clinical and experimental data bearing on the efficacy of hypnosis as a means of memory enhancement. The 2 main problems associated with the use of hypnosis in the legal investigative context—confabulation and the creation of pseudo-memories—are discussed, with particular reference to the demand characteristics of the investigative context. Some recent court cases where confabulation was demonstrated unequivocally and several recent American state supreme court rulings are presented. The need for stringent safeguards proposed by M. T. Orne (1978) is discussed, and the relevance of the American experience of the past 15 yrs to the Canadian context is emphasized. (French abstract) (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention and therapy of acute radiation-related morbidity of the skin and mucosa. II, Recommendations of the literature

Changes in nuclear and nucleolar morphometric parameters were investigated by image analysis procedures in human breast MCF-10F epithelial cells expressing different stages of the tumourigenic progression after benzo[a]pyrene (BP) transformation (BP1, BP1-E, and BP1-E1 cell lines), and additionally transfected with the c-Ha-ras oncogene (BP1-Tras cell line). Nuclear pleomorphism was evident in all the transformed cells. The analysis of different morphometric parameters did not show a clear relationship between specific nuclear and nucleolar changes and the expression of the different stages of the tumourigenesis, with the exception of the nucleolar size, which could be associated to the expression of the tumourigenic phenotype, and a nucleolar area/nuclear area ratio, which discriminated the immortalized, the transformed, and the tumourigenic phenotypes from one another. The nuclear morphometric data established for the BP-transformed cells and for the cells additionally transfected with the c-Ha-ras oncogene were suggestive of complex and distinct morphofunctional mechanisms involving the in vitro transformation of the MCF-10F cells. The nuclear changes found in the BP1-Tras cell line were assumed to be related to the additional effects and/or enhanced genomic instability induced by transfection with the ras oncogene.