Faculty Bibliography

BACKGROUND:The value of additional photoprotection provided by use of high SPF sunscreens is controversial and limited clinical evidence exists. OBJECTIVE:To compare the sunburn protection provided by SPF100+ and SPF50+ sunscreen in conditions of actual use. METHODS:199 healthy men and women (≥18 years) participated in a natural sunlight, single exposure, split face, randomized, double blind study in Vail, Colorado. Each participant wore both sunscreens simultaneously during activities with no usage restrictions other than treatment area designation. Erythema was clinically assessed the day following exposure. Comparative efficacy was evaluated through bilateral comparison of sunburn between treatment areas and erythema score as evaluated separately for each treatment area. RESULTS:Following an average 6.1 ± 1.3 hours of sun exposure, investigator blinded evaluation identified 55.3% (110/199) of the participants as more sunburned on the SPF50+ and 5% (10/199) on the SPF100+ protected side. Post exposure, 40.7% (81/199) of the participants exhibited increased erythema scores ≥ 1 on the SPF50+ protected side as compared to 13.6% (27/199) on the SPF100+. LIMITATIONS/CONCLUSIONS:Single day exposure may not extrapolate to benefits of longer-term protection. CONCLUSION/CONCLUSIONS:SPF100+ sunscreen was significantly more effective in protecting against sunburn than SPF50+ sunscreen in actual-use conditions. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov(NCT02952235).

Melanoma is a type of cutaneous malignancy responsible for thousands of deaths every year. Despite improvements in therapuetics and identification, incidence rate and the total number of associated deaths for melanoma continue to increase annually. Melanoma outcomes are impacted by numerous variables, and sex, age, race, socioeconomic status, and tanning bed use have been studied extensively as they relate to melanoma. Additionally, this article explores the trends in the changing melanoma incidence and mortality rates per modifiable variable and subpopulation.

Melanoma, an aggressive skin cancer, requires timely diagnostics for improved patient outcomes. The ABCDE criteria-assessing asymmetry, borders, color, diameter, and evolution-serve as foundational guidelines for early detection. Non-invasive tools like dermoscopy, total body photography, and advanced imaging techniques enhance visualization of skin lesions, while artificial intelligence-driven algorithms improve diagnostic accuracy. Despite these advancements, biopsy remains the gold standard for definitive diagnosis. This multifaceted approach highlights the need for integrating traditional methods with innovative technologies to optimize melanoma evaluation and management, ultimately leading to better patient outcomes.

Genomic advancements have transformed melanoma prognosis by identifying key genetic alterations that influence disease progression and treatment outcomes. Gene expression profiling (GEP) tests, including the 31-GEP, 11-GEP, and 8-GEP + CP, refine traditional staging by stratifying patients based on recurrence and metastasis risk. These tests enhance clinical decision-making by guiding sentinel lymph node biopsy selection, surveillance intensity, and adjuvant therapy use. Studies confirm their prognostic accuracy, linking GEP results to survival outcomes. Despite their potential, challenges like cost and validation limit widespread adoption. As research progresses, integrating genomic data with traditional staging could further personalize melanoma management.

Mohs micrographic surgery (MMS) is a tissue-sparing surgical technique that is the standard of care for treatment of several cutaneous malignancies. Current US and international guidelines recommend wide local excision as the first-line surgical therapy for noninvasive melanoma, and use of MMS may be appropriate for melanoma-in-situ, lentigo maligna, and potentially thin invasive malignant melanoma. Based on available literature, MMS can potentially result in lower recurrence rates of melanoma, especially when using immunostaining. This chapter explores the existing evidence supporting MMS for treatment of melanoma as well as its challenges.

Metastatic melanoma is an aggressive and treatment-resistant skin cancer with a low 5-year survival rate of 27%. Historically considered radioresistant, melanoma's response to radiation therapy (RT) has evolved, especially when integrated with systemic therapies like immune checkpoint inhibitors (ICIs). RT is now recognized for its utility in local control, palliative care, and brain metastasis management. Emerging evidence shows RT's synergy with ICIs through mechanisms like the abscopal effect. This article explores RT's evolving role in metastatic melanoma treatment, focusing on integration with modern therapies and ongoing research into optimizing outcomes.