Dissertations / Theses on the topic 'Skin Cancer Victoria Prevention'

Class of 2009 Abstract
OBJECTIVES: Skin cancer is particularly prevalent in Arizona, with incidence rates ranking number two worldwide. Pharmacists are useful advocates for educating patients about the risks of skin cancer and methods of prevention. This study was conducted to assess pharmacists’ knowledge of skin cancer and their demographics and to evaluate how these factors impact skin cancer prevention patient counseling. METHODS: Participants were recruited using a listserv from pharmacists that were members of the Arizona Pharmacy Alliance or preceptors of the University of Arizona College of Pharmacy. Subjects completed an online questionnaire consisting of knowledge- based questions, questions about patient counseling preferences and subject demographics. RESULTS: The average score by pharmacists on the Skin Cancer and Sun Exposure Knowledge Indicator was 5.8 + 1.9. Pharmacists living in Arizona for longer times were more likely to know the minimum recommended SPF of sunscreen for adults to use when outdoors (p=0.003) and the factors associated with malignant melanoma prognosis/survival (p=0.004), but were less likely to know the definition of ABCD acronym (p=0.027). Having a family or friend diagnosed with any form of skin cancer or precancerous skin condition led to more pharmacists knowing the risk factors for developing melanoma (p=0.046) and knowing how often to apply water resistant sunscreen (p=0.035). CONCLUSIONS: The length of pharmacy practice in Arizona and having a family member or close friend affected by skin cancer significantly impacted a pharmacists’ knowledge of skin cancer.

Skin cancer is the most commonly diagnosed cancer in the United States; it is estimated that the number of Americans who have had a skin cancer in the last three decades is higher than the number for all other cancers combined. Fortunately, there are known prevention methods, effective treatments available for early-stage cases, and behavioral practices that can reduce the risk of secondary and recurrent cancer. However, in spite of these, skin cancer incidence continues to increase and mortality still exists, making skin cancer prevention of the utmost importance. Outlined in this dissertation are factors identify as associated with the development, diagnosis, and prognosis of skin cancer that could be targeted during primary, secondary, and tertiary skin cancer control and prevention interventions in Arizona. Utilizing the 2013 Arizona Behavior Risk Factor Surveillance System survey, aim one of this dissertation investigates factors associated with UVR exposure (as measured by sun protection use and sunburn history) that could be targeted during primary prevention efforts in order to reduce the disease burden. The results of this research are that approximately 20% of Arizona adults are protecting their skin with sunscreen or protective clothing every time they go outdoors and 28% of Arizona adults experienced one or more sunburns in the past 12 months. Compared with males, females were more likely to report that they protect their skin. Other factors associated with use of sun protection were higher education, higher income, good general health, and living in a more urban area. A recent history of sunburns was associated with being non-Hispanic white and a history of indoor tanning. Given that melanoma diagnosed in the earlier progression of the disease is associated with improved prognosis and significantly higher survival rates, secondary prevention interventions are essential to skin cancer control efforts. The second aim of this dissertation was to gain a better understanding of patient and community factors associated with late-stage melanoma diagnosis in Arizona. Based on Arizona Cancer Registry and community-level data, among melanoma patients there is evidence for significant associations between late-stage of diagnosis and being male (OR 1.22 [95%CI1.09-1.37]), non-white (OR 3.15 [95%CI 2.01-4.95]), and Hispanic (OR 2.13 [95%CI 1.61-2.81]). Additionally, access to care was found to influence stage of diagnosis. Residence in a rural area, compared to an urban area, was associated with late-stage melanoma diagnosis. Similarly, zip codes with a dermatologist density of less than 6 dermatologists per 100,000 persons, when compared to zip codes with greater than 12 dermatologists per 100,000 persons, were associated with late-stage melanoma diagnosis. A travel distance to the reporting hospital or clinic of over 40 miles, as compared to travel distance of 20 miles or less, was also associated with melanoma cases being diagnosed at a late-stage. Even after the progression of the disease, skin cancer survivors' prognosis and quality of life can be improved by following healthy lifestyle recommendations. The final aim of this study was to examine at what levels skin cancer survivors are meeting the recommended healthy lifestyle behaviors. Skin cancer survivors' behaviors were similar, with the exception of increased sun protection use, to behaviors among survivors of other non-skin forms of cancer. However, skin cancer survivors were more likely to practice healthy lifestyle behaviors than individuals without a reported history of cancer. Although skin cancer survivor did report better behaviors than non-cancer controls, there was still a considerable amount of survivors not practicing the recommended behaviors. Over 25% of skin cancer survivors only protected their skin during the summer or not at all. Additionally, low levels of other healthy lifestyle behaviors were noted among skin cancer survivors: slightly over half of skin cancer survivors met the physical activity recommendations, approximately half reported receiving their annual influenza vaccination, and less than 20% consumed 5 fruit or vegetable servings daily. This research suggests that there are opportunities for improved clinical and public health interventions targeted at increasing sun protection use, preventing sunburns, reducing disparities associated with late-stage melanoma, and improving healthy lifestyle behaviors among skin cancer survivors.

Thesis (Honors paper)--Florida State University, 2008.
Advisor: Mary A. Gerend, PhD, Florida State University, College of Arts & Sciences, Dept. of Psychology. Includes bibliographical references.

Background: Skin cancer is the most common cancer worldwide and one of the most preventable cancers. Despite prevention efforts, skin cancer incidence continues to rise among adolescents. This is especially a challenge for the state of Arizona, which has a high incidence of skin cancer. The inconsistent evidence-based practice guidelines for skin cancer prevention create challenges for counseling adolescents. The knowledge, attitudes, and practices of primary skin cancer prevention by nurse practitioners who care for adolescents is unknown in Arizona or elsewhere in the U.S. Purpose: This doctor of nursing practice project investigates knowledge, attitudes, and practices of skin cancer primary prevention by Arizona nurse practitioners caring for adolescents on an outpatient basis and determines congruency of their counseling with primary prevention guidelines. Methods: The design is descriptive cross-sectional. An online survey using Qualtrics software was distributed via professional listservs to eligible Arizona nurse practitioners currently in practice. Participants' knowledge of skin cancer, skin cancer prevention, and current practice guidelines and recommendations were assessed using multiple choice items. Participants' attitudes regarding counseling for skin cancer prevention within the adolescent population and current nurse practitioner behaviors, in relation to current practice guidelines, were measured using Likert-type scales. Outcomes: Thirty-nine nurse practitioners responded to the online survey. Participant overall knowledge regarding skin cancer was moderate to low, and less was known about skin cancer in adolescents. Despite participants' overall positive attitudes toward skin cancer prevention, they reported low rates of skin cancer prevention counseling for adolescents in practice. Skin cancer prevention recommendations, identified by participants as used in practice, were not congruent with established clinical guidelines on counseling for primary prevention of skin cancer in adolescents.

It is widely known that skin cancer is a significant health concern. Studies show that farmers and ranchers are at increased risk of skin cancer, presumed to be secondary to the increased time they spend outdoors and their increased exposure to the sun. This study examined the current sun protection techniques utilized by a sample of North Dakota individuals, who spend the majority of their occupational time outdoors. After collecting information reflecting demographics and current sun protection measures practiced by the sample, educational material focusing on skin cancer prevention and healthy sun behaviors was distributed to the individuals and the primary researcher gave an educational power-point presentation. A post-survey was then given to the sample, identifying the effectiveness of the education, as well as the intentions of the individuals to change. It was found that 74% of participants had never received previous instruction on sunscreen use. The computed odds ratio showed that the intent of participants to observe sunscreen use after the presentation was 3.47 times than before. An encouraging 88% of the participants reported increased intent to complete a self-skin examination post-intervention. The research showed areas for improvement from numerous aspects, including provider and patient education, encouraging preventative techniques while working outdoors, and encouraging regular self-skin examinations. The findings support the importance and effectiveness of verbal communication of health care providers in the family practice setting to verbally discuss skin cancer and sun protection behaviors with their patients, as well as provide patients with written educational information. By identifying the benefits, barriers, and intent of the participants to change, interventions may be implemented.

The folates are a family of structurally similar, water-soluble, B vitamins, documented to play prominently in human health and disease. The potential impact of folate nutrition has been demonstrated by large-scale epidemiological and nutritional studies indicating that decreased folate intake increases the risk of cancer development. Human skin is particularly prone to the development of carcinomas and it is established that skin cancer risk correlates with exposure to the complete carcinogen ultraviolet radiation (UVR) in the form of sunlight. Recently a link between skin, sunlight, and folate has emerged from studies demonstrating that folate species are degraded by exposure to wavelengths of UVR contained within the solar spectrum. It is hypothesized that the unique physiology, function, and environment of skin combine to make skin tissue prone to folate deficiencies and that folate supplementation is a promising strategy for the prevention of skin cancer. However, many questions regarding folate nutrition within human skin must be answered before strategies to modulate folate nutrition may be rationally designed and safely implemented. This work presents novel means to examine skin-specific folate nutrition, including an analytical method to quantify individual folate species in human keratinocytes adaptable for the analysis of intact skin tissue and innovative cultured keratinocyte models of both acute and chronic folate deficiencies. It is demonstrated that folate deficiencies in skin tissue are possible and even likely as proliferating human keratinocytes are unable to maintain intracellular folate concentrations when nutrient conditions are limited and exposure to UVR results in biologically relevant folate degradation. Folate deficiency in human keratinocytes is observed to have potential pro-carcinogenic consequences including S-phase proliferation arrest, increased inherent DNA strand breaks, increased uracil misincorporation into DNA, and deficiencies in DNA damage repair, which are reversed when folate nutrient levels are optimized. The presented work characterizes the relationship between intracellular folate species and environmental carcinogens known to induce skin cancer and addresses challenges facing supplementation strategies for specifically improving folate nutriture in human skin. In total, this report broadens our understanding of folate nutrition in human skin and demonstrates that optimization of folate nutrition holds promise as a cancer preventive strategy.

Radiation dermatitis is a common side effect of external beam radiation therapy. The purpose of this study was to evaluate the effectiveness of applying an aloe vera based skin gel to the target area skin in preventing the development of radiation dermatitis to postlumpectomy/ mastectomy patients receiving external beam radiation therapy in an ambulatory radiation-oncology clinic in the southeastern region of the United States. In this descriptive correlational study, a convenience sample of willing participants (n=18) was followed from initial treatment through the one-month follow-up examination to assess the intensity of their skin reaction. Five research questions were examined pertaining to the relationship between prognostic indicators and the development of radiation dermatitis when RadiacareR gel was used before and throughout external beam radiation therapy post-mastectomy or post-lumpectomy. The prognostic indicators used in this study were: Breast size > C-cup, prior chemotherapeutic exposure, length of incision, age of client, and weight changes since diagnosis. Analysis of Variance (ANOVA) and Pearson's Correlation Coefficients were used in the data analysis with a confidence of p=0.05. This study indicated that breast size and weight changes were the most prognostic of the factors studied. The small sample size and lack of randomization or control group limit the generalizability of these findings to clinical practice; however, it does support the need for continued research in this area. Recommendations for future studies include comparing Body Mass Index (BMI) to incidence and determining a relationship between gel use and treatment breaks and if there is a difference in the length of time until the skin is restored to baseline upon completion of therapy.

Class of 2015 Abstact
Objectives: The purpose of this study was to describe differences in pharmacists' children and personal skin cancer prevention strategies, clinical outcomes, knowledge and to determine if there were differences based on attending pharmacy school in Arizona or other states. The skin cancer prevention behaviours of pharmacists were also compared to the general public. Methods: Pharmacists registered and living in Arizona with an email address with the State Board of Pharmacy were eligible for the study. A questionnaire was developed based on questions from the NHIS survey. The questionnaire was administered by using an electronic, on-line survey form. Results: Graduates of non-Arizona schools were significantly more likely to have completed a CE course on skin cancer prevention than the Arizona group (16% vs. 6%). Both groups were not significantly different in gender and work sites. The knowledge of pharmacists in both groups were very similar (p > 0.1) except for knowledge of photosensitivity for certain drug classes (p = 0.043).Pharmacists were most knowledgeable on risk factors for melanoma (97%) Pharmacists were least knowledgeable on when sunscreen should be applied (20%) responded correctly and the minimum age for using sunscreen in children (26%) responded correctly. Pharmacists were more than twice as likely to use sunscreen as the general population (72% vs. 31%). Conclusions: Pharmacist graduates of non-Arizona schools (Non-Arizona group) used a similar number of skin cancer prevention strategies as graduates of Arizona schools (Arizona group). Sun protective measures utilized by parents for their children were superior to parents' own self-care sun protection measures.

Melanoma is a life threatening type of skin cancer with numerous fatal incidences all over the world. The 5-year survival rate is very high for cases that are diagnosed in early stage. So, early detection of melanoma is of vital importance. Except for several techniques that clinicians apply so as to improve the reliability of detecting melanoma, many automated algorithms and mobile applications have been developed for the same purpose.In this paper, deep learning model designed from scratch as well as the pretrained models Inception v3 and VGG-16 are used with the aim of developing a reliable tool that can be used for melanoma detection by clinicians and individual users. Dermatologists who use dermoscopes can take advantage of the algorithms trained on dermoscopical images and acquire a confirmation about their diagnosis. On the other hand, the models trained on clinical images can be used on mobile applications, since a cell phone camera takes images similar to them.The results using Inception v3 model for dermoscopical images achieved accuracy 91.4%, sensitivity 87.8% and specificity 92.3%. For clinical images, the VGG-16 model achieved accuracy 86.3%, sensitivity 84.5% and specificity 88.8%. The results are compared to those of clinicians, which shows that the algorithms can be used reliably for the detection of melanoma.

Background: Skin cancer is the most common form of cancer in the United States and is a public health concern. There are over 5 million new cases of keratinocyte skin cancer (KC) (previously known as non-melanoma skin cancer) and over 65,000 new cases of melanoma annually in the United States. Skin cancer is highly preventable, although prevention methods are not commonly practiced. Nurse practitioners have a key role in educating and encouraging patients to practice skin cancer prevention methods. Purpose/Aims: The purpose of this project was to determine whether a brief educational video can improve nurse practitioner knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. Methods: A single subject pre-test post-test design guided this project. Participants completed an online pretest assessing skin cancer knowledge, attitudes, and behaviors. Following the pretest participants were given access to the video intervention. The intervention included information about skin cancer and published guidelines about skin cancer prevention counseling. Changes in knowledge, attitudes, and behaviors and satisfaction with the intervention were assessed through a post-test. Results: A total of 30 eligible Arizona nurse practitioners completed both the pretest and posttest surveys. There was a statistically significant increase (p=.000) in knowledge from 64.17% on the pretest to 87.5% on the posttest. Attitudes about skin cancer and skin cancer counseling were fair on the pretest and significantly improved (p=.000) on the posttest. On the pretest, nurse practitioners had poor attitudes regarding skin cancer prevention counseling practice behaviors. These attitudes favorably increased (p=.009) on the posttest. Self-reported practice behaviors also improved significantly following the intervention (p=.000). Participants' attitudes regarding the intervention were generally favorable. Conclusions: A brief educational intervention offered online to nurse practitioners is highly effective for improving their knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. The intervention is feasible to administer and is acceptable to nurse practitioners.

The incidence of melanoma and non‐melanoma skin cancer is continuing to increase worldwide. Melanoma is the sixth most common cancer in the United States, making skin cancer a significant public health issue. Photo chemoprevention with natural products is an effective strategy for the control of cutaneous neoplastic. Polyphenols from fruits have been shown to protect the skin from the adverse effects of solar UVR, cancer, and the growth of cancer stem cells. In particular, blueberries are known for their high concentration of phenolic compounds that have the high antioxidant capacity, and their effectiveness in reducing UV damage and, therefore, skin cancer. In Matar's lab, we have shown that Polyphenol-Enriched Blueberry Preparation (PEBP), derived from biotransformation of blueberry juice through fermentation, is effective for targeting skin cancer stem cell proliferation in different skin cancer cell lines. We predicted that PEBP affects melanoma skin cancer stem cells (MCSCs) epigenetically by targeting miRNA pathways. We observed the effects of PEBP on sphere growth and cell motility in vitro. We performed RT2-qPCR analyses to determine PEBP influence on miRNA in B16F10 spheres. We transfected B16F10 cells with miR-200b and performed western blotting analyses. Our results demonstrated that PEBP reduced sphere growth and cell migration, and up regulated miR-200b expression in different biological settings. Inhibition of miR-200b increased Zinc Finger E-Box Binding Homeobox 1 (ZEB1) expression. Consequently, PEBP may influence MCSCs through miRNA pathways. Elucidating the mechanisms by which PEBP modulates CSCs biological behavior by controlling miRNAs will enhance our understanding of the molecular mechanisms in skin cancer chemoprevention and might result in their use as natural photo-protectants in skin cancer.

Master of Science
Department of Human Nutrition
Weiqun Wang
Exercise has been previously reported to lower cancer risk through reducing circulating IGF-1 and IGF-1-dependent signaling in mouse skin cancer models. This study is to investigate the underlying mechanisms by which exercise might impact IGF-1 pathway regulated by p53 and p53-related proteins in mouse skin epidermis. Female SENCAR mice were pair fed an AIN-93 diet with or without 10-week treadmill exercise at 20 m/min for 60 min daily. Animals were topically treated with TPA or vehicle control 2 hours before sacrifice and the target proteins in the epidermis were assessed by immunohistochemistry and Western blotting. Under TPA or vehicle treatment, MDM2 was significantly reduced in exercised mice compared with sedentary control. Meanwhile, p53 was significantly increased. In addition, p53 transcription target proteins p21, IGFBP-3, and PTEN were elevated in response to exercise. An interaction between exercise and TPA was observed on the decrease of MDM2 and increase of p53, but not p53 down-regulated proteins. Taken together, exercise appears to activate p53 by reducing MDM2 suppression, resulting in enhanced expression of p21, IGFBP-3 and PTEN that might further induce a negative regulation of IGF-1 pathway and therefore contribute to the observed cancer prevention by exercise in this mouse skin cancer model.

Non-melanoma skin cancers (NMSC) are the most common malignant neoplasms in the White population, afflicting about 20% at some point in life (1, 2). The incidence of NMSC is increasing by two to three percent per year (2). Strategies for NMSC prevention are important because, although NMSC does not result in substantial mortality, it does have the ability to cause substantial morbidity, including disfigurement and loss of function, and treatment is costly (3).The goals of the dissertation were to explore the reliability, clinical, epidemiological, pharmacoepidemiological and statistical issues that potentially affect studies of NMSC prevention. This dissertation utilized three studies designed to examine ways to prevent NMSC recurrence or identify early markers in the development of NMSC (SKICAP-AK trial, n=2,297, SKICAP-SCC/BCC trial, n=525, and Biomarkers 1 Study, n=91). The goals of this research were to examine the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on NMSC recurrence, determine if there was a dose response for treatment with the drugs isotretinoin and retinol on the recurrence of NMSC, and examine factors related to reliability of NMSC risk assessment questionnaires often used in epidemiological and clinical studies.Overall, the findings of this research indicated that NSAIDs likely play a role in reducing the risk of developing an SCC in those at high risk, and that the use of oral isotretinoin and retinol play little role in reducing the risk of redevelopment of NMSC in those who have had a previous NMSC. In addition, there was evidence of substantial reproducibility for factors related to assignment into skin cancer risk group and self-reported history of skin lesions, with self-reported sun sensitivity questions being somewhat less reliable. More research should be done to address the role of NSAIDs in chemoprevention at both the basic science level and epidemiological level. Additional secondary analyses of large data sets that contain information on NMSC and NSAIDs use should be conducted in order to further strengthen the argument that NSAIDs play a role in reducing NMSC occurrence. Future work should focus on determining the specific populations that could benefit from NSAIDs use for the reduction of NMSC.

Indoor tanning (IT) before the age of 35 increases one’s risk for melanoma by 75%, and epidemiological data show a 6.1% annual increase in the incidence of melanomas in white women younger than age 44 in the US. Population-based studies reveal that 15% of adolescents and 8% to 14% of their primary caregivers have engaged in IT in the past year. The compelling case for IT being a significant risk factor for melanoma, together with the high rates of IT in teen girls and their mothers, provided a strong rationale for conducting an antitanning intervention directed at mother-daughter dyads. This study evaluated a strategy designed to prevent skin cancer in adolescent girls by using mothers as change agents to effectively communicate the risks of IT and to encourage teens to avoid high risk IT behaviors. Mother-daughter dyads were recruited over the telephone, randomly assigned to the intervention or control group, and surveyed on IT risk constructs including tanning-specific knowledge and communication. Forty-two mother-daughter dyads completed baseline surveys in the summer of 2012. Mothers in the intervention group were given a handbook educating them on the dangers of IT and how to convey information about skin cancer prevention to their daughters and encouraged to talk with their daughters about the issues covered in the handbook over a 1-month period. Participants completed follow-up assessments in October 2012 and January 2013. Among teens, past 3-month IT frequency, intentions, and willingness decreased in intervention group teens, while intentions and willingness increased among control teens. Intervention teens exhibited lower IT attitudes and higher levels of perceived susceptibility to appearance damage and health effects from IT when compared to control teens. Intervention teens reported higher levels of maternal monitoring and lower levels of maternal permissiveness toward IT. Qualitative data indicated mothers responded positively to the handbook, and it encouraged tanning-specific discussions with their daughters. Mothers provided suggestions on how to improve the handbook, that once incorporated, should lead to improved intervention efficacy. Overall, study results indicated this intervention strategy is feasible, as mothers did communicate with their teens and were able to convey the antitanning messages.

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

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

Sun exposure is implicated in the majority of skin cancer cases so it is important to identify interventions that successfully decrease young people's tanning behaviors and increase their sun protection behaviors. Research suggests that interventions that focus on the more immediate appearance related effects of tanning, rather than on future health risks, may be more effective in altering UV-related behaviors. Dissonance induction is a strategy that has been used to successfully alter other health-related behaviors. This study sought to determine if a dissonance induction intervention might be similarly successful in changing UV-related behaviors. The study yielded mixed findings. Relative to a healthy lifestyle control condition, the tanning condition resulted in a decrease in intentions to tan indoors and in actual number of hours spent sunbathing. The tanning condition also resulted in an increase in intentions to use sunscreen on the body. However, compared to a psycho-educational control condition, both groups seemed to have been equally successful and unsuccessful on different measures of UV-related behaviors and intentions. The findings of this study suggest that a dissonance induction intervention for tanning may be successful, but that it requires further study. Despite the mixed findings, this study serves as an important step in the search for successful interventions for decreasing tanning behaviors and increasing sun-protection behaviors.

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas
As doenças oncológicas são um dos principais problemas a nível mundial e, em Portugal, representam a segunda causa de morte. Os rastreios oncológicos têm como objetivo a deteção precoce de cancro permitindo a redução da mortalidade e, muitas vezes, da incidência. Não existe um rastreio único para todos os tipos de cancro, mas sim exames específicos para os diferentes tipos. A sua realização deve ter como base uma ponderação dos riscos e benefícios em conjunto com o médico. Em Portugal, atualmente, apenas existe consenso relativamente à utilidade da realização dos programas de rastreio do cancro do colo do útero, do cancro da mama e do cancro colo-retal. Este trabalho tem como objetivo a revisão dos diferentes rastreios oncológicos realizados em Portugal no que respeita aos tipos de cancro pertencentes ao Plano Oncológico Nacional 2001-2005. Dada a sua importância, também será referido o cancro da próstata, o cancro da pele e os marcadores tumorais. Cancer is a worldwide major problem, being the second cause of death in Portugal. Cancer screenings are aimed at early cancer detection allowing the reduction of mortality and also often incidence. There is no single screen for all types of cancer, but specific tests for the various types. Its achievement should be based regarding the risks according to the medical opinion. In Portugal, currently, there is only consensus regarding the usefulness of the screening programs for cervical cancer, breast cancer and colorectal cancer. The current study aims to review the different cancer screenings performed in Portugal according the National Oncological Plan 2001-2005. Due to its importance, it will be also exposed prostate cancer, skin cancer and tumor markers.

Sun safe behaviour is a modifiable behaviour and therefore the potential for change is large. Targeted interventions that use multi-strategy or healthy public policy approaches may be successful at increasing sun safe behaviours and creating supportive environments that promote positive health outcomes. This research considered sun safety, and more specifically shade creation, within the domain of public places that integrate human leisure-time exposure to ultraviolet radiation (UVR). It was felt that the potential for behaviour change through the adoption of healthy public policy was probably greatest in this domain. Specifically this research considered the creation of shade as a complementary strategy to individual sun safe behaviours, and investigated how best local governments can create shade at public facilities. Policy considerations that have the potential to increase shade creation were identified within the many activities at the local government level. For example, legislation and regulations that control a community's infrastructure may be modified to mandate shade for walkways, public parks and swimming pools for new communities. Policy changes may also promote or change behaviours related to sun safety. Authors have stated that strategies such as governmental legislation and policies that are being used to diffuse an innovation should be investigated to determine the factors that have played crucial roles in the process (Oldenburg, Hardcastle & Kok, 1997a). This research considered these comments and aimed to identify public health efforts to increase shade that expanded beyond targeting individuals, to include activities that create complex changes in community design and facilities through the introduction of healthy public policies. Aims: The research described in this thesis was designed to provide local governments throughout Australia, and more specifically Queensland, with information and a model of how best to develop and adopt healthy public policy to ensure public health issues that had no legal standing were integrated into their core business. An important aspect of the study was to investigate local governments that were at different stages of the policy process to enable the identification of a range of inhibiting and facilitating factors. Methods: This research relied on case studies of local governments that examined the variables such as policy design, key stakeholders, resources, sources of diffusion, community involvement, environment receptivity, policy outcomes and barriers to successful healthy public policy development, adoption and where possible, implementation. In total, fifteen local governments were included in this study. Qualitative research methods were used extensively to gather data within each case study setting. Open-ended questionnaires were used to target three groups of professionals. These included key informants, additional stakeholders and professionals external to the local government setting. Key informants were identified as the primary policy adopter. Additional stakeholders had the potential to influence shade creation within the Local government context, and the professionals external to the local government were identified as being able to assist in developing, adopting and implementing shade creation policies within the community setting. Data were predominantly analysed through content analysis where major themes were identified in responses, coded and counted to identify the leading trends. Relation to Previous Work: All Queensland local governments (n=125) were forwarded a copy of "Shade Creation for Local Government - Policy Guidelines" (AIEH, 1995) which contained a model shade creation policy, in 1995. This dissemination occurred prior to this research commencing. Results: This research subsequent to this dissemination of information identified a number of facilitating and inhibiting factors for the development and adoption of healthy public policy at the local government level. The facilitating factors that promoted policy development and adoption included the nature and position of local government within the community, the perceived priority of the policy process, the disposition of local government Officers and the extent of community or external stakeholder input. Five primary barriers to the development and adoption of healthy public policy at the local level included deficiencies in policy design, inadequate political support, organisational barriers, resource constraints and external factors such as the risk of vandalism. Based on these findings a systems model was developed with the objective of guiding the development and adoption of healthy public policy at the local level. Conclusion: This research identified that although many local governments have been creating shade for many years, this has been occurring on an ad hoc basis, without support from formal policies or procedures. Without formal policy, there is little galvanising infrastructure to ensure shade creation activities occur into the future, regardless of staffing levels and interests or funding. This research investigated this process and identified a number of factors that inhibit and facilitate the healthy public policy process in the local government setting.

The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused on the science of health behavior joins the American Academy of Dermatology, the American Academy of Pediatrics, and a host of other national and international organizations in support of a total ban on indoor tanning for minors under the age of 18. According to the International Agency for Research on Cancer, artificial sources of ultraviolet radiation are in the highest category of carcinogens, joining tobacco and asbestos. Strong evidence links indoor tanning to increased risk for melanoma with repeated exposure during childhood being associated with the greatest increase in risk. Several countries and five US states have passed legislation banning indoor tanning in minors. We strongly encourage the remaining US states to do the same in an effort to protect children and prevent new cases of melanoma. SBM also strongly encourages research that explores the use of tanning beds in the home. Home-based indoor tanning has the potential to be especially dangerous given the complete absence of safety regulations. Children are currently protected from exposure to health-harming substances like tobacco and lead; thus, legislation protecting them from artificial sources of ultraviolet radiation is yet another important step forward in improving public health.

Outdoor workers are exposed to high levels of ultraviolet radiation (UVR) and may thus be at greater risk to experience UVR-related health effects such as skin cancer, sun burn, and cataracts. A number of intervention trials (n=14) have aimed to improve outdoor workers’ work-related sun protection cognitions and behaviours. Only one study however has reported the use of UV-photography as part of a multi-component intervention. This study was performed in the USA and showed long-term (12 months) improvements in work-related sun protection behaviours. Intervention effects of the other studies have varied greatly, depending on the population studied, intervention applied, and measurement of effect. Previous studies have not assessed whether: - Interventions are similarly effective for workers in stringent and less stringent policy organisations; - Policy effect is translated into workers’ leisure time protection; - Implemented interventions are effective in the long-term; - The facial UV-photograph technique is effective in Australian male outdoor workers without a large additional intervention package, and; - Such interventions will also affect workers’ leisure time sun-related cognitions and behaviours. Therefore, the present Protection of Outdoor Workers from Environmental Radiation [POWER]-study aimed to fill these gaps and had the objectives of: a) assessing outdoor workers’ sun-related cognitions and behaviours at work and during leisure time in stringent and less stringent sun protection policy environments; b) assessing the effect of an appearance-based intervention on workers’ risk perceptions, intentions and behaviours over time; c) assessing whether the intervention was equally effective within the two policy settings; and d) assessing the immediate post-intervention effect. Effectiveness was described in terms of changes in sun-related risk perceptions and intentions (as these factors were shown to be main precursors of behaviour change in many health promotion theories) and behaviour. The study purposefully selected and recruited two organisations with a large outdoor worker contingent in Queensland, Australia within a 40 kilometre radius of Brisbane. The two organisations differed in the stringency of implementation and reinforcement of their organisational sun protection policy. Data were collected from 154 male predominantly Australian born outdoor workers with an average age of 37 years and predominantly medium to fair skin (83%). Sun-related cognitions and behaviours of workers were assessed using self-report questionnaires at baseline and six to twelve months later. Variation in follow-up time was due to a time difference in the recruitment of the two organisations. Participants within each organisation were assigned to an intervention or control group. The intervention group participants received a one-off personalised Skin Cancer Risk Assessment Tool [SCRAT]-letter and a facial UV-photograph with detailed verbal information. This was followed by an immediate post-intervention questionnaire within three months of the start of the study. The control group only received the baseline and follow-up questionnaire. Data were analysed using a variety of techniques including: descriptive analyses, parametric and non-parametric tests, and generalised estimating equations. A 15% proportional difference observed was deemed of clinical significance, with the addition of reported statistical significance (p<0.05) where applicable. Objective 1: Assess and compare the current sun-related risk perceptions, intentions, behaviours, and policy awareness of outdoor workers in stringent and less stringent sun protection policy settings. Workers within the two organisations (stringent n=89 and less stringent n=65) were similar in their knowledge about skin cancer, self efficacy, attitudes, and social norms regarding sun protection at work and during leisure time. Participants were predominantly in favour of sun protection. Results highlighted that compared to workers in a less stringent policy organisation working for an organisation with stringent sun protection policies and practices resulted in more desirable sun protection intentions (less willing to tan p=0.03) ; actual behaviours at work (sufficient use of upper and lower body protection, headgear, and sunglasses (p<0.001 for all comparisons), and greater policy awareness (awareness of repercussions if Personal Protective Equipment (PPE) was not used, p<0.001)). However the effect of the work-related sun protection policy was found not to extend to leisure time sun protection. Objective 2: Compare changes in sun-related risk perceptions, intentions, and behaviours between the intervention and control group. The effect of the intervention was minimal and mainly resulted in a clinically significant reduction in work-related self-perceived risk of developing skin cancer in the intervention compared to the control group (16% and 32% for intervention and control group, respectively estimated their risk higher compared to other outdoor workers: , p=0.11). No other clinical significant effects were observed at 12 months follow-up. Objective 3: Assess whether the intervention was equally effective in the stringent sun protection policy organisation and the less stringent sun protection policy organisation. The appearance-based intervention resulted in a clinically significant improvement in the stringent policy intervention group participants’ intention to protect from the sun at work (workplace*time interaction, p=0.01). In addition to a reduction in their willingness to tan both at work (will tan at baseline: 17% and 61%, p=0.06, at follow-up: 54% and 33%, p=0.07, stringent and less stringent policy intervention group respectively. The workplace*time interaction was significant p<0.001) and during leisure time (will tan at baseline: 42% and 78%, p=0.01, at follow-up: 50% and 63%, p=0.43, stringent and less stringent policy intervention group respectively. The workplace*time interaction was significant p=0.01) over the course of the study compared to the less stringent policy intervention group. However, no changes in actual sun protection behaviours were found. Objective 4: Examine the effect of the intervention on level of alarm and concern regarding the health of the skin as well as sun protection behaviours in both organisations. The immediate post-intervention results showed that the stringent policy organisation participants indicated to be less alarmed (p=0.04) and concerned (p<0.01) about the health of their skin and less likely to show the facial UV-photograph to others (family p=0.03) compared to the less stringent policy participants. A clinically significantly larger proportion of participants from the stringent policy organisation reported they worried more about skin cancer (65%) and skin freckling (43%) compared to those in the less stringent policy organisation (46%,and 23% respectively , after seeing the UV-photograph). In summary the results of this study suggest that the having a stringent work-related sun protection policy was significantly related to for work-time sun protection practices, but did not extend to leisure time sun protection. This could reflect the insufficient level of sun protection found in the general Australian population during leisure time. Alternatively, reactance caused by being restricted in personal decisions through work-time policy could have contributed to lower leisure time sun protection. Finally, other factors could have also contributed to the less than optimal leisure time sun protection behaviours reported, such as unmeasured personal or cultural barriers. All these factors combined may have lead to reduced willingness to take proper preventive action during leisure time exposure. The intervention did not result in any measurable difference between the intervention and control groups in sun protection behaviours in this population, potentially due to the long lag time between the implementation of the intervention and assessment at 12-months follow-up. In addition, high levels of sun protection behaviours were found at baseline (ceiling effect) which left little room for improvement. Further, this study did not assess sunscreen use, which was the predominant behaviour assessed in previous effective appearance-based interventions trials. Additionally, previous trials were mainly conducted in female populations, whilst the POWER-study’s population was all male. The observed immediate post-intervention result could be due to more emphasis being placed on sun protection and risks related to sun exposure in the stringent policy organisation. Therefore participants from the stringent policy organisation could have been more aware of harmful effects of UVR and hence, by knowing that they usually protect adequately, not be as alarmed or concerned as the participants from the less stringent policy organisation. In conclusion, a facial UV-photograph and SCRAT-letter information alone may not achieve large changes in sun-related cognitions and behaviour, especially of assessed 6-12 months after the intervention was implemented and in workers who are already quite well protected. Differences found between workers in the present study appear to be more attributable to organisational policy. However, against a background of organisational policy, this intervention may be a useful addition to sun-related workplace health and safety programs. The study findings have been interpreted while respecting a number of limitations. These have included non-random allocation of participants due to pre-organised allocation of participants to study group in one organisation and difficulty in separating participants from either study group. Due to the transient nature of the outdoor worker population, only 105 of 154 workers available at baseline could be reached for follow-up. (attrition rate=32%). In addition the discrepancy in the time to follow-up assessment between the two organisations was a limitation of the current study. Given the caveats of this research, the following recommendations were made for future research: - Consensus should be reached to define "outdoor worker" in terms of time spent outside at work as well as in the way sun protection behaviours are measured and reported. - Future studies should implement and assess the value of the facial UV-photographs in a wide range of outdoor worker organisations and countries. - More timely and frequent follow-up assessments should be implemented in intervention studies to determine the intervention effect and to identify the best timing of booster sessions to optimise results. - Future research should continue to aim to target outdoor workers’ leisure time cognitions and behaviours and improve these if possible. Overall, policy appears to be an important factor in workers’ compliance with work-time use of sun protection. Given the evidence generated by this research, organisations employing outdoor workers should consider stringent implementation and reinforcement of a sun protection policy. Finally, more research is needed to improve ways to generate desirable behaviour in this population during leisure time.

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Nesse trabalho analisaremos o direito à saúde no meio ambiente de trabalho da construção civil, através da perspectiva do risco, prevenção e políticas públicas, com ênfase na atividade que expõe o trabalhador à radiação solar e que, por conseguinte, pode ser fator decisivo para o diagnóstico do câncer de pele. As peculiaridades que envolvem o trabalhador exposto à radiação solar são complexas e vão desde a falta de previsão legal do agente radiação solar como insalubre até a dificuldade em se caracterizar o nexo causal câncer de pele como doença ocupacional. A análise estará focada no risco advindo da exposição à radiação e nos seus efeitos legais. Nesse contexto de risco, a prevenção é essencial para concretizarmos o direito à saúde no local de trabalho, e essa extensão do direito à saúde é fruto de uma leitura constitucional, em especial a partir do art. 196 e do art. 7º, inciso XXII, que faz alusão à prevenção no meio ambiente de trabalho. Nesse contexto, as políticas públicas mostram-se como um instrumento garantidor da prevenção às doenças e da concretização do direito à saúde no ambiente de trabalho. Para esse estudo, utilizaremos a teoria dos sistemas sociais como referencial teórico.
In this work we analyze the right to health in the working environment of construction, from the perspective of risk, prevention and public policy, with emphasis on the activity that exposes the worker to solar radiation and therefore can be a decisive factor for diagnosis of skin cancer. The peculiarities involving workers exposed to solar radiation are complex and range from the lack of legal provision Agent solar radiation as unhealthy to the difficulty in characterizing the causation of skin cancer as an occupational disease. The analysis will focus on risk from radiation exposure and its legal effects. In this context of risk, prevention is essential to materialize the right to health in the workplace, and this extension of the right to health is the result of a constitutional reading, especially from the art. 196 and Art. 7, paragraph XXII, which alludes to the prevention in the work environment. In this context, public policies are shown as an instrument guaranteeing the prevention of diseases and the implementation of right to health in the workplace. For this study, we use the theory of social systems as a theoretical framework.

O objetivo desta tese de mestrado é compreender a influência de campanhas de marketing social na prevenção do cancro da pele, com foco em Portugal, com o caso da APCC (Associação Portuguesa de Cancro Cutâneo). Em primeiro lugar, foi realizada uma revisão de literatura sobre marketing social para compreender o seu conceito, evolução, aplicações e ferramentas para estudar a mudança de comportamentos. A revisão de literatura versou também o tema do cancro da pele, para perceber o que é o cancro da pele, que tipos existem, de forma a contextualizar o tema. Além disso, foram também destacadas as campanhas de prevenção de cancro da pele em Portugal com o caso da APCC. Em segundo lugar, foram recolhidos e analisados dados através de uma combinação de pesquisa primária (entrevistas a pessoas envolvidas nas campanhas da APCC) e pesquisa secundária (análise de dados de questionários sobre comportamentos de prevenção do cancro da pele realizados em campanhas da APCC). Por fim, foi apresentado um brief para uma campanha de marketing social, com a apresentação de recomendações sobre a segmentação, os objetivos de comunicação e a estratégia do marketing mix para futuras campanhas de prevenção do cancro da pele a serem implementadas em Portugal.
The objective of this master thesis is to understand the influence of social marketing campaigns on skin cancer prevention, focusing on Portugal with the case of APCC (Associação Portuguesa de Cancro Cutâneo). Firstly, it was conducted a literature review on social marketing to understand its concept, evolution, applications and tools to study behavior change. The literature also included the topic of skin cancer, to comprehend what it is and its types, providing background on the topic. Moreover, there was a focus on skin cancer prevention campaigns, zooming in on Portugal with the case of APCC. Secondly, data was collected and analyzed through a combination of primary research (interviews to people involved in APCC campaigns) and secondary research (analysis of data of surveys about skin cancer prevention behaviors conducted in APCC campaigns). Finally, it was presented a social marketing campaign brief, providing recommendations on segmentation, communication objectives and marketing mix strategy for future skin cancer prevention campaigns to be implemented in Portugal.

The presence of dark melanin (eumelanin) within human epidermis represents one of the strongest predictors of skin cancer risk. Topical rescue of eumelanin synthesis, previously achieved in “redhaired” Mc1r-deficient mice, demonstrated significant protection against UV damage and skin carcinogenesis. However, application of a topical strategy for human skin pigmentation has not been achieved, largely due to the greater barrier function of human epidermis. Salt Inducible Kinase (SIK) has been demonstrated to regulate MITF, the master regulator of pigment gene expression, through its effects on CREB regulated transcription coactivator (CRTC) and CRE binding protein (CREB) activity. Here, we describe the development of small molecule SIK inhibitors that were optimized for human skin penetration, resulting in MITF upregulation and induction of melanogenesis. When topically applied, pigment production was induced in Mc1r-deficient mice and normal human skin. These findings are the first to demonstrate a realistic pathway towards UV-independent topical modulation of human skin pigmentation, potentially impacting UV protection and skin cancer risk. Although MITF normally functions as a regulator of pigmentation, if amplified MITF can serve as a melanoma oncogene shown to cooperate with BRAF (V600E) to induce tumorigenic transformation of melanocytes . Only 10% of melanomas carry an MITF amplification emphasizing the need to identify pathways that modulate MITF expression . Liver kinase B1 (LKB1) regulates many cancer-relevant cell phenotypes and is a known SIK inducer . However, the interaction of the LKB1-SIK pathway and MITF in melanoma formation is not fully understood. Overall 49% of human melanomas in The Cancer Genome Atlas contain aberrations in LKB1, SIK1, SIK2, SIK3, CRTC1, CRTC2, CRTC3, or MITF . Here, we report that the LKB1-SIK axis can negatively regulate MITF expression, and our data suggests this is through increasing CRTC2 cytoplasmic localization. Rescue of LKB1 in LKB1-null G361 melanoma cells suppresses cell proliferation. MAP kinase pathway activation suppresses MITF, and knockdown of all three SIK isoforms rescues MITF expression in NRAS (Q61R) expressing melanocytes. Overall, our findings establish SIK and LKB1 as regulators of the CRTC-CREB-MITF pathway and through this regulation, potentially play a critical role as tumor suppressors in melanoma oncogenesis.

Research Doctorate - Doctor of Philosophy (PhD)
Skin cancer is the most prevalent, preventable cancer in Australia (Cancer Council Australia, 2015). However, the majority of skin cancers could be prevented “if the public could be persuaded to adequately protect themselves from the sun” (Jones, Rees, Johnson, & Tang, 2005, p. 189). Celebrity spokespersons are often engaged to feature in public service announcements that promote skin cancer prevention messages. However, the impact of a celebrity without medical training, in comparison to a spokesperson with medical training is unknown. This program of work investigated the impact of different spokespersons on delivering skin cancer prevention messages. It explored the association between spokesperson type (celebrity, medical practitioner, and celebrity doctor), intention to act, and message acceptance. Source credibility and its three character dimensions (expertise, physical attractiveness, and trustworthiness) provided the theoretical underpinning. Nationwide, participants (n=1,191) took part in one of three online studies. Study 1 examined the effect of spokesperson type and source expertise on intention to act. Study 2 explored the relationship between spokesperson type, level of source attractiveness, and audience age on message acceptability. Study 3 assessed the association between spokesperson type, payment disclosure, source trustworthiness, and intention to act. Participants were directly asked their preferred option for spokesperson in each study. Source expertise had a significant impact on intention. Source attractiveness, however, did not impact message acceptance, with the hypothesised relationship of attractiveness being valued more by younger audiences not substantiated. Though trustworthiness had a significant effect on intention, disclosure of spokesperson payment information did not impact trustworthiness. Finally, participants for each study overwhelmingly reported preference of receiving information from a medical practitioner spokesperson (92%–97%) rather than a celebrity or a celebrity doctor. More research on this topic is recommended, including theoretical applications and collecting additional information to explore the impact of spokesperson on different socio-economic groups. Results support use of medical practitioner spokespersons for cancer prevention messages. Physical attractiveness is not important for message acceptance, nor is disclosure of spokesperson payment essential.