Advances in the management of UVR-induced skin cancer
Authors: Eggert Stockfleth, Christian Surber, Claas Ulrich
Journal: British Journal of Dermatology (2009)

The field of dermatology covers a number of malignancies, which are either among the most dangerous (malignant melanoma) or among the most numerous (basal cell carcinoma, actinic keratoses and invasive squamous cell carcinoma) of all cancer entities in mankind.1, 2 Over the past decade, the continued progress in basic science, applied research in clinical medicine and pharmacology, refined diagnostic tools as well as innovative campaigns on primary and secondary skin cancer prevention has engendered into a far better understanding of skin cancer dynamics. However, accumulating knowledge and tools about skin cancer is markedly contrasted by the annually growing numbers of skin cancer incidence rates in almost all countries world wide, populated by fair skinned people.3 Solar UV-exposure is the most important environmental risk factor for the development of non melanoma skin cancer. Ultraviolet radiation is, however, not an inevitable carcinogen and acute or chronic symptoms of over exposure are clearly visible on everybody's skin. Sunburn is the effect most frequently experienced by virtually everybody and is clearly attributed to excessive solar UV-B exposure. Despite the remembered discomfort from past episodes, about a third of US residents report at least one sunburn per year.4 This supplement, initiated and kindly supported by an unrestricted grant by the European Skin Cancer Foundation, is aimed at physicians and other health care providers, medical students, basic researchers but also the pharmaceutical industry, insurance companies and health care politicians who are interested in the current state of epidemiology, prevention, education, diagnosis, treatment and aftercare of UV-related skin diseases. It represents a cooperative effort arouse out of an international, professional collaboration and includes a number of manuscripts dealing with specific parts and aspects of our integrated model of skin cancer management. (Fig. 1) Management continuum of UVR-induced skin cancer. Comprehensive education is a prerequisite for effective prevention. A reliable diagnosis ensures a successful treatment. Completed treatment requires studious aftercare. The first article explains the mutual approach of the common research, education and prevention network 'European Skin Cancer Foundation', extending an open invitation onto everybody willing to network in this challenging field. It is followed by an article on primary photo-protection in a network of Kindergartens in Germany. On a political level, the finding that sunburn in childhood is responsible for the most aggressive form of skin cancer – the malignant melanoma – resulted in the fact that protection of children was expressly established as the core task in a recommendation from the European Union [EU Commission 'on the efficacy of sunscreen products and the claims made relating thereto' 22nd September 2006 22006/647/EC]. This article shows practical implications and a simple model to translate this political aim into 'palpable' local reality. The third and fourth article give an upate of sunscreens as a preventative measure in malignant melanoma and present a survey on sunscreen knowledge. Autier highlight the abuse of sunscreen for international sun exposure. Novel diagnostic tools with a potential of being complementary (if not more) to established standards of sun screen testing is presented and Osterwalder and his group discuss the current controversy on sun screen grading and labelling in their article 'sun protection factors – a world wide confusion'. A series of articles examines the role of UV in the induction and modulation of photodermatoses and autoimmune disorders and two articles present data on in the challenging yet fascinating 'fast-track skin cancer model', represented by chronically immunoscompromised patients such as organ transplant recipients and the prevention of NMSC in this group with the consequent use of sunscreen. For a long time it is known that sufficient UV-protection may lead towards insufficient vitamin D levels and the expert in this field, Jörg Reichrath, gives recommendations about the evidence for substitution in those patient groups. Gillian Murphy presents recent insights on UV-immunology and immunosuppression and Jürgen Eberle together with Martin Leverkus present an update on UV-mediate skin cancerogenesis. This issue closes with an impressive analysis of the costs induced by the treatment of malignant melanoma and non-melanoma skin cancer and as a final highlight Sinclair and Foley present actual data and information on results and lessons to learn from world famous Australian skin cancer prevention campaign Slip! Slop! Slap!. We hope that this joint effort of researchers and dermatologists from three continents have produced a comprehensive and useful work, and that the readers will benefit from this supplement as much as we have enjoyed collaborating on it. Berlin and Basel, July 2009 ES is the head of the foundation board for the European Skin Cancer Foundation; CS is associated with Spirig Pharma AG, Manufacturer of skincare products; CU is a member of the Speakers bureau of Spirig Pharma AG.