Claudia C. Ramirez

Skin cancer as an occupational disease: the effect of ultraviolet and other forms of radiation

Over 1 million Americans will be diagnosed with skin cancer this year, more than all other cancers combined. 1 Currently, it is estimated that one in five Americans will develop skin cancer during their lifetime, the majority diagnosed with nonmelanoma skin cancer (NMSC), which includes basal cell (BCC) and squamous cell (SCC) carcinomas. 2 The incidence of both NMSC and melanoma is increasing and melanoma is increasing more rapidly than any other reported cancer. 3–5

Double-Blind, Randomized, Placebo-Controlled, Prospective Study Evaluating the Tolerability and Effectiveness of Imiquimod Applied to Postsurgical Excisions on Scar Cosmesis

Background It has been reported that topical application of imiquimod 5% cream induces interferon-α, an antifibrotic cytokine. Objective To determine the tolerability and effectiveness on the cosmetic outcome of the application of imiquimod to postsurgical excision sites. Materials and Methods A prospective, double-blinded, randomized, vehicle-controlled trial was conducted among 20 patients with two skin lesions clinically diagnosed as melanocytic nevi. Imiquimod 5% cream was applied to one of the sutured surgical wounds starting the night of the excision nightly for a period of 4 weeks. The second sutured excision site was treated with vehicle cream. Scar cosmesis, erythema, pigmentary alterations, induration, tenderness, and pain were assessed using a visual analogue scale 2, 4, and 8 weeks after surgery. Results Eighteen subjects completed the study, with a total of 36 excision sites; no wound site dehisced, and no signs of infection were noted. Surgical wounds treated with imiquimod had more erythema, pigmentary alterations, and lower cosmesis rated by the investigator compared with wounds treated with placebo, both becoming nonsignificant in further evaluations. For pigmentary alterations, induration, and cosmesis rated by the patients, no statistically significant difference between treatment groups was observed at week 8. Conclusion Treatment of surgical excision-site wounds with imiquimod was well tolerated and without serious adverse events. Evaluations for cosmesis of placebo-treated surgical sites were better than imiquimod-treated sites at week 8, becoming nonsignificant later.

Lipid-lowering agents and risk of melanoma.

Dear Sir, We read with interest the article entitled ‘‘Cancer Risk Among Statin Users: A Population-Based Cohort Study’’ published in the 1 December edition of the International Journal of Cancer, in which Friis et al. reported a reduction of cancer risk in statins users. Other studies have suggested that statins and other lipid-lowering agents (in contrast to the findings of Friis et al.) to be beneficial for other diseases including cancer. Two randomized prospective studies conducted to evaluate the effects of lovastatin and gemfibrozil in coronary artery disease observed a significantly lower incidence of melanoma in patients randomized to receive those lipid-lowering agents. To evaluate the role of statins and other lipid-lowering agents for chemoprevention of melanoma, we evaluated whether the use of lipid-lowering agents decreases the incidence of melanoma outcomes (new melanoma development, recurrence, or metastasis) in high-risk patients. Reviewing computerized medical records at Miami VA Medical Center, we retrospectively examined the association between the use of lipid-lowering agents and melanoma incidence in high-risk subjects: white subjects with a previous diagnosis of cutaneous melanoma (1996–2003). Eighty-three subjects (96.4% men) with melanoma were included, of which 31 patients used lipid-lowering agent (LLA) drugs (6 used gemfibrozil, 1 lovastatin and 24 simvastatin) and 52 patients did not. Usage time ranged from 30 to 2,070 days, with a median of 517. Of the 52 patients who did not use LLA drugs, 4 developed new melanoma (7.7%), 2 had reoccurrence (3.9%) and 4 had metastases develop (7.7%). We did not observe any new melanoma or reoccurrence in patients on LLA drugs. Three patients did develop metastasis (9.7%) in this group. The combined melanoma outcome for nonusers was 17.3% vs. 9.7% for LLA drug users (p5 0.34). Statins have an antitumor effect by several mechanisms, including blocking the cell cycle in G1 phase, inducing apoptosis and decreasing tumor invasiveness by inhibiting Rho activation, which controls cells motility.3,4 In vitro, tumors such as neuroblastoma, acute myeloid leukemia and squamous cell carcinoma of the head and neck have responded to lovastatin. Animal studies suggest statins have a chemopreventive effect in several neoplasias, such as breast, colon, lung, myeloid leukemia and melanoma. A synergic effect with other antineoplastic agents, including doxorrubicine and selective cyclooxygenase inhibitors, has been observed.5,6 While our small sample size limited the statistical power, we found a similar trend for improvement in melanoma risk. Further evaluation of the anticancer effects for statin drugs with a larger sample is warranted. Yours sincerely,