Search Results (4,464)

Immunosuppressed patients have a substantially increased risk for developing skin cancer. Therefore, it is mandatory that such patients are adequately informed and aware of skin cancer and their increased risk to modify their behavior. Numerous studies have evaluated the topic, but no synthesis of their findings exists. The protocol of this systematic review was registered on PROSPERO (CRD42024618851) and its reporting followed the PRISMA-2020 guideline. To identify all studies assessing knowledge or perception of skin cancer in immunosuppressed patients, forward and backward citation tracking was employed in addition to an electronic literature search across five databases. For the risk of bias (ROB) assessment, the Joanna Briggs Institute checklist for prevalence studies was used. Quantitatively comparable outcomes were meta-analyzed, while all others were qualitatively synthesized. Thirty-two reports comprising 4214 patients were included. Acknowledging substantial heterogeneity between studies, just over two thirds of patients recalled having been informed about their increased skin cancer risk (pooled proportion: 68.34%, 95% confidence interval (CI): 55.48–78.90). Awareness of the increased risk for skin cancer varied widely (34.5–100%), and pooled mean Skin Cancer and Sun Knowledge scores were 14.77 (CI = 8.57–20.96). About half of those patients asked about risk factors for skin cancer knew that immunosuppression was among them. This indicates that immunosuppressed patients are insufficiently educated about their increased skin cancer risk. However, the high heterogeneity in the synthesized outcomes and the minimal proportion (3%) of low ROB ratings for the included studies call for further research to better understand the awareness of skin cancer risk in this vulnerable population. Full article

Cancer remains one of the leading causes of global mortality, with its incidence continuing to rise due to population growth, aging, lifestyle factors, and environmental exposures. Despite significant advances in early diagnosis and therapeutic strategies, the clinical management of cancer is still hindered by drug resistance, limited selectivity, and treatment-related toxicity. Consequently, increasing attention has been directed toward natural products as sources of novel anticancer agents with improved efficacy and reduced adverse effects. Pogostemon cablin (patchouli), a medicinal plant widely used in traditional medicine, has emerged as a promising candidate owing to its diverse bioactive constituents and broad pharmacological properties. This review systematically summarizes and critically evaluates current evidence on the anticancer potential of patchouli leaves, with particular emphasis on molecular mechanisms and translational relevance. Based on available experimental and preclinical studies, patchouli and its major phytochemicals exhibit notable anticancer activity against a wide range of malignancies, including endometrial, ovarian, liver, skin, nasopharyngeal, prostate, hematological, colorectal, and lung cancers. Mechanistically, these effects are primarily associated with the modulation of apoptosis, cell cycle regulation, oxidative stress, and key oncogenic signaling pathways, as well as potential synergistic interactions with conventional chemotherapeutic agents. Overall, this review highlights the therapeutic promise of patchouli leaves as a source of anticancer agents, identifies current knowledge gaps, and outlines future research directions to facilitate their development and clinical translation. Full article

Background/Objectives: Basal cell carcinoma (BCC) is the most common skin cancer and may negatively influence a patient’s well-being despite low mortality. This systematic review and exploratory meta-analysis evaluated dermatology-related quality of life, as measured exclusively by the Dermatology Life Quality Index (DLQI), in patients with BCC and other non-melanoma skin cancers (NMSC). Instruments other than the DLQI, including disease-specific measures of appearance, scarring, fear of recurrence and treatment satisfaction, were outside the scope of the quantitative synthesis. Methods: A systematic search of the PubMed, Scopus, and the Web of Science was conducted until 5 April 2026 following the PRISMA guidelines. Studies reporting DLQI outcomes in adult patients with BCC, squamous cell carcinoma (SCC), or NMSC were included. Pooled baseline DLQI scores and pre- to post-treatment changes were calculated using a random effects model. Results: Six studies were included. The pooled baseline DLQI score was 3.76 (95% CI: 2.18–5.33) in the BCC-only analysis and 4.07 (95% CI: 2.99–5.15) in an exploratory expanded analysis including SCC and broader NMSC populations; this estimate should be interpreted as a summary of heterogeneous keratinocyte cancer populations rather than as representative of BCC alone. None of the included studies had an untreated comparator group, so the pre–post results describe the change in DLQI score following treatment rather than a treatment effect. The pooled reduction was 2.38 points (95% CI: 0.56–4.19) in the BCC-only and 1.90 points (95% CI: 0.84–2.96) in the expanded pre–post analysis. Both fall below the minimal clinically important difference for the DLQI of approximately four points. Heterogeneity was very high throughout (I² > 95% for baseline analyses), so the pooled means summarize highly dispersed evidence and cannot be read as representative average values. Surgical treatment appeared to show a greater improvement in DLQI scores compared with the single available radiotherapy cohort. This comparison should be interpreted descriptively due to the inclusion of only one radiotherapy study. Conclusions: Patients with BCC and other NMSCs experience measurable impairment in dermatology-related quality of life before treatment, although the overall burden is generally mild. Treatment is associated with improvement in DLQI scores; however, the magnitude of change is modest and may not consistently exceed thresholds considered clinically meaningful. Evidence regarding differences between treatment modalities remains limited, particularly for radiotherapy, and further prospective studies using disease-specific quality-of-life instruments are needed. Full article

Background/Objectives: Class imbalance is one of the major challenges in automated skin lesion classification since the number of categories of malignant and clinically significant skin lesions is normally less than the benign ones. However, due to this imbalance, deep convolutional neural networks (CNNs) tend to overlook minority classes and fail to recognize them with an acceptable accuracy, which leads to a decrease in diagnostic reliability. A wide range of imbalance mitigation techniques has been suggested, but their effectiveness is found to differ significantly depending on CNN architecture, and detailed comparative studies of these techniques for a consistent experimental setup are still limited. Methods: This study proposes a comprehensive benchmarking framework that tests sixteen class imbalance mitigation methods by applying them to six pretrained CNN architectures—EfficientNet-B0, EfficientNet-B3, ResNet50, DenseNet121, InceptionV3 and MobileNetV2—on the official ISIC 2019 skin lesion dataset. The tested techniques are conventional resampling techniques, synthetic sample generation techniques, algorithm-level learning techniques, data augmentation techniques, and hybrid techniques. The dataset was partition into a separate training set and testing set, and stratified cross-validation was only conducted on the training set to ensure the study was fair and reproducible. Both models have been optimized with the same optimizer, learning rate, batch size, epochs and preprocessing pipeline. The performance of the models was evaluated by computing the accuracy, precision, recall and F1-score. Results: The experimental results show that the effect of class imbalance mitigation is very specific to the underlying CNN architecture. The traditional undersampling and oversampling methods yielded only moderate improvements, while feature space and hybrid methods yielded more consistent results. When coupled with EfficientNet-B3, Balanced MixUp improved the overall performance of the model by achieving an accuracy of 92.39%, an increase in precision of 93.3%, a recall of 91.36%, and an F1-score of 92.33%. However, some architectures such as ResNet50 performed better with iterative learning techniques, such as Cumulative Learning and Yielding Multi-Fold Training, which suggests that there is a diversity in how different network architectures react to imbalance mitigation methods. Conclusions: This paper highlights the importance of selecting appropriate technique–architecture combinations for addressing long-tailed data distributions in medical imaging. The proposed benchmarking framework provides valuable insights for developing robust and reliable deep learning systems for skin lesion classification and other medical imaging tasks affected by severe class imbalance. Full article

Immunotherapy delivers a fundamental shift in the treatment of multiple cancers, offering hope for patients with cancer. Unlike conventional therapies, it leverages the patient’s immune system to precisely identify and destroy cancer cells. The remarkable journey of immunotherapy’s has revolutionized oncology and paved the way for the development of modern immunotherapies. Several approaches are applied for immunotherapy, including immune checkpoint inhibitors, adoptive cell therapies, cancer vaccines, tumor microenvironment reprogramming, monoclonal antibodies, cytokine therapies, oncolytic virus therapy and combination strategies. Various immunotherapies are being used for different types of cancers like skin, lung, bladder, kidney, liver, breast and blood cancers. Despite providing an effective cancer treatment, immunotherapies face some challenges in their clinical implementation. To overcome these limitations, future directions emphasize the development of personalized and combination therapies, the incorporation of AI and a good delivery system. The main aim of this review is to give an overview of the journey of evolution, different approaches, limitations, advances and future development for immunotherapy in cancer treatment. Full article

Background/Objectives: The implementation of tattoo-free radiotherapy (RT) for breast cancer reflects an effort to mitigate the psychological distress of permanent marks through surface-guided techniques, while simultaneously evaluating its utility in meeting setup precision requirements. Methods: In this prospective trial, patients were positioned for breast cancer RT including regional nodal irradiation exclusively using surface-guided RT (SGRT). Cone-beam computed tomography (CBCT) was acquired at each fraction as the ground truth to analyze translational setup deviations. Results: A total of 457 paired SGRT–CBCT data points in 30 patients were acquired. A residual translational setup deviation of ≤6 mm was achieved in 97.6% of all fractions with a median deviation of 2 mm (range: 0–12). Neither age, comorbidities, body mass index, extent of target volumes, choice of breathing technique, nor patient-reported symptoms (pain, dermatitis, anxiety) correlated significantly with setup deviations. The median in-room positioning time was 92 s (range: 20 s–6 min and 37 s) and significantly prolonged in patients with an elevated BMI and higher grades of pain and skin dermatitis, and for chest wall irradiation. Manual assessment of the accuracy of regional nodal CTVs in each CBCT relative to the planning CT showed good-to-minor deviations in 99.7% (Level 1/2), 95.0% (Supra-/infraclavicular), and 90.8% (Internal mammary), respectively, with major deviations in only 0.3% (Level 1/2), 5.0% (Supra-/infraclavicular) and 9.2% (Internal mammary). A forward dose calculation on CBCT geometries (n = 86) revealed high median CTV dose coverage of 100.0% (range: 57.1–107.7%) of the original target dose for all lymph node levels combined. Conclusions: The tattoo-free positioning setup for regional nodal irradiation in breast cancer patients exhibited pronounced robustness, maintaining its accuracy and reliability irrespective of patient-, tumor-, or treatment-specific variables with high clinical efficiency. However, larger cohorts are required to confirm whether these parameters genuinely operate independently of setup accuracy. Full article

Background/Objectives: Melanoma remains one of the most aggressive skin cancers worldwide, with rising incidence and persistent therapeutic challenges, particularly in advanced diseases. Drug repositioning has emerged as a cost- and time-efficient strategy for identifying adjunctive treatments, and antihypertensive medications have attracted attention for their potential off-target antitumor and immunomodulatory effects. This scoping review aimed to map and critically appraise the evidence on the repositioning of antihypertensive drugs for melanoma management. Methods: The review followed the JBI methodology, and the results were reported in accordance with the PRISMA-ScR guidelines. Searches were conducted in July 2025 and updated in May 2026 in PubMed, Scopus, and Web of Science. For Methodological Quality and Risk-of-bias assessment, the SYRCLE Risk of Bias tool was employed for animal studies. Results: This review included 37 studies. β-Blockers, particularly propranolol, were the most frequently investigated agents (n = 21). Several studies reported antiproliferative, pro-apoptotic, antiangiogenic, and immunomodulatory effects; however, these findings were not uniform. Absent direct antiproliferative effects, biphasic dose responses, lack of angiogenic effects, and outcomes dependent on drug concentration, treatment schedule, and experimental model were also reported. Agents targeting the renin–angiotensin system and calcium channels similarly produced heterogeneous and context-dependent findings. The animal studies frequently presented high or unclear risk of bias, particularly because of incomplete reporting of randomization, allocation concealment, and blinding. No formal methodological quality assessment was performed for the in vitro studies. Conclusions: Antihypertensive agents, particularly β-blockers, show promising but heterogeneous preclinical signals in melanoma. However, the available evidence is not sufficient to establish reproducible efficacy or translational validity. Standardized and methodologically rigorous preclinical studies are required before these agents can be considered for clinical investigation as adjunctive melanoma therapies. Full article

Background/Objectives: Actinic keratosis is an intraepithelial lesion that may progress into squamous cell carcinoma; therefore, all lesions should be treated. The study aimed to investigate the potential correlations between patient and lesion characteristics, treatment option choice, and clinical outcomes, analyzing long-term real-world data. Methods: A retrospective study was conducted in a specialized hospital in Milan. Data on patients with actinic keratoses were collected from January 2018 to July 2024. Results: A total of 369 patients were included, with normal weight (58%), higher educational level (83%), personal skin cancer history (51%), childhood sunburns (68%), and face localization (70%), with multiple contiguous distribution (54%) of lesions. In total, 45.5% received multiple treatments. Field-directed therapies were prescribed in 84% of cases (32% of complete clearance). A total of 43% were lost to follow-up. Higher educational level, personal and familiar skin cancer history, previous atypical naevus excision, higher naevus count, and multiple treatments (p < 0.05) were associated with regularity in visit attendance. In multivariable analysis, immunosuppression (OR = 5.01 [0.97, 29.5], p = 0.056) and multiple contiguous lesions (OR = 4.62 [1.75, 14.7], p = 0.004) were found to be significantly associated with incomplete clinical response. Conclusions: Real-world data on patients with actinic keratoses may help identify more personalized management strategies that influence treatment outcomes and adherence to follow-up. Full article

Background: This study evaluates transdermal delivery of tamoxifen (TXN) as an alternative to the oral route of administration in treating breast cancer, which is the leading cause of cancer-related death in women globally. Oral TXN, a Class II drug, is associated with first-pass metabolism and serious side effects, including secondary cancers. Objectives: To enhance transdermal delivery, lipid-based transethosomes (TRS) were formulated using three different 2⁴ factorial designs with various non-ionic surfactants, including Tween 20^®, Span 20^®, and Span 80^®. Methods: Optimized TRS formulations were incorporated into HPMC-based gels and characterized for morphology, drug content, pH, viscosity, spreadability, ex vivo skin penetration, and deposition. Additionally, cytotoxicity and stability were assessed. Results: All TXN-TRS gels were suitable for transdermal use; however, Span 20^®-based TRS gel demonstrated the highest skin penetration (40.3 ± 1.5 µg/cm²), representing a 127-fold enhancement rate compared with the non-ethosomal TXN gel. In line with the enhanced penetration profile, cellular studies on MCF-7 cells showed concentration-dependent cytotoxicity, reaching 91.24 ± 1.01% inhibition at 2% w/w after 72 h, with an IC₅₀ value of 0.85 ± 0.02% w/w. Stability testing showed all formulations were more stable under refrigeration than at dry room temperature storage, supporting their potential as preclinical transdermal tamoxifen delivery platforms. Conclusions: Span 20^®-based TXN transethosomal gel markedly enhanced skin penetration while maintaining potent cytotoxic activity, supporting its further preclinical evaluation as a promising transdermal alternative to oral tamoxifen. Full article

Ultraviolet (UV) radiation is a major environmental factor contributing to photoaging, oxidative stress, inflammation, DNA damage, and photocarcinogenesis. Conventional UV filters, although widely used in sunscreen formulations, are associated with limitations including photoinstability, photocatalytic ROS generation, potential toxicity, and environmental concerns. In recent years, plant-mediated nanomaterials have emerged as promising multifunctional photoprotective systems, combining UV attenuation with antioxidant, anti-inflammatory, and biologically adaptive properties. Plant extracts are increasingly used as reducing and stabilising agents in the green synthesis of metal and metal oxide nanoparticles. Among these, ZnO and TiO₂ serve as established inorganic UV filters, whereas Ag and Au nanoparticles have primarily been investigated for their antioxidant, anti-inflammatory, antimicrobial, and ROS-modulating properties, which may indirectly enhance photoprotection. In parallel, plant-derived organic nanoparticles and herbal nanocomposites have demonstrated enhanced biocompatibility and multifunctional performance. This review critically examines the current landscape of plant-mediated photoprotective nanomaterials, focusing on the mechanistic interplay among optical UV attenuation, reactive oxygen species (ROS) modulation, and cellular signalling regulation. Particular emphasis is placed on structure–function relationships governing nanoparticle size, surface chemistry, bandgap properties, antioxidant behaviour, and biological interactions. The review further discusses translational challenges, including reproducibility, standardisation, scalability, long-term safety, regulatory classification, and limitations in benchmarking. Importantly, current evidence suggests that no single material system simultaneously optimises UV-blocking efficiency, ROS control, biocompatibility, and industrial scalability, highlighting the need for multifunctional hybrid design strategies. Finally, future perspectives involving predictive nanoengineering, computational modelling, machine learning-guided optimisation, and adaptive photoprotective systems are discussed as emerging directions for next-generation sustainable photoprotective technologies. Full article

Background/Objectives: Metatypical basal cell carcinoma (MTBCC) is a rare and aggressive variant of non-melanoma skin cancer (NMSC) characterised by overlapping histological features of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). Owing to its increased propensity for local invasion, recurrence, and metastasis, MTBCC poses diagnostic and therapeutic challenges. This study aimed to characterise the epidemiological, histopathological, and clinical features of MTBCC and to evaluate temporal changes in tumour characteristics and aggressiveness before, during, and after the COVID-19 pandemic. Methods: A retrospective cohort study was conducted on 129 histologically confirmed MTBCC lesions diagnosed in the Pathology Department of the Mures Clinical County Hospital, Targu Mures, Romania, between January 2017 and December 2025. Demographic data, tumour location, histological subtypes, differentiation of the squamous component, aggressiveness parameters, and volumetric measurements of tumours and excision specimens were analysed. Volumetric analyses were restricted to cases with complete three-dimensional measurements. Statistical comparisons were performed across demographic variables and the following three time periods: pre-pandemic, pandemic, and post-pandemic. Results: The median age at diagnosis was 71 years, with a slight male predominance (p = 0.25) and a significant predominance of patients from urban areas (p < 0.001). Most tumours were located in the head and neck region. Mixed-type MTBCC was significantly associated with higher tumour aggressiveness (p = 0.0019) and with high-risk histological subtypes, particularly micronodular and adenoid–cystic variants. Tumour volume showed a significant inverse correlation with year of diagnosis (p = 0.0139; r = (−) 0.50), whereas excision specimen volume differed significantly according to year of diagnosis (p = 0.0425). Neither tumour volume nor excision specimen volume was associated with histopathological aggressiveness. Conclusions: Metatypical basal cell carcinoma is a rare skin malignancy in which biological behaviour appears to be determined primarily by histopathological architecture rather than tumour size. Mixed-type lesions were associated with significantly higher aggressiveness, underscoring the need for accurate histopathological assessment. These findings support a pathology-driven approach to management and emphasise the importance of adequate surgical treatment and long-term follow-up in patients with MTBCC. Full article

Introduction: Melanoma is a chronic disease that significantly affects patients’ daily functioning and emotional well-being. Beyond its somatic burden, it often leads to substantial changes in quality of life (QoL). This study aimed to assess illness acceptance among melanoma patients and examine its associations with selected clinical characteristics (disease stage, pruritus and time since diagnosis), psychological distress (depression and anxiety) and QoL. Materials and Methods: A cross-sectional study was conducted between June 2025 and February 2026 at two tertiary oncology centers in Poland. Initially, 191 consecutive melanoma patients were recruited, of whom 162 (58.6% men; mean age 59.8 ± 13.7 years) were included in the final analysis (response rate: 84.8%). Participants completed validated questionnaires assessing illness acceptance (Acceptance of Illness Scale (AIS)), depression (PHQ-9, HADS-D), anxiety (GAD-7, HADS-A), and QoL (DLQI). Statistical analyses were performed, with p < 0.05 considered statistically significant. Results: The mean AIS score was 13.28 ± 7.50 points, indicating a remarkably low level of illness acceptance. In the multivariable linear regression analysis, greater depressive symptoms (HADS-D: β = −1.16, 95% CI −1.79 to −0.54; p < 0.001) and more advanced melanoma stage (β = −1.52, 95% CI −2.92 to −0.12; p = 0.034) were independently associated with lower illness acceptance. In addition, illness acceptance showed significant correlations with depressive symptoms, anxiety symptoms, and dermatology-related QoL, whereas no significant associations were observed with most evaluated demographic and clinical variables. Conclusions: Patients with melanoma demonstrated remarkably low illness acceptance. Depressive symptoms and more advanced melanoma stage were independently associated with lower illness acceptance. These findings support the integration of psychological assessment into comprehensive melanoma care. Full article

Cutaneous melanoma and basal cell carcinoma (BCC) represent the two primary malignancies driven by solar ultraviolet (UV) radiation. To map the spatial topology and distance dependence of their mutational signatures, we deployed new analytical bioinformatics workflow utilizing two convergent strategies: a data-driven read-level phasing framework to discriminate between collateral mutational events versus independent ones and a hypothesis-driven spatial permutational simulation model to capture density-dependent local deviations. A whole-genome analysis employing this framework unexpectedly reveals two fundamentally distinct lesion-processing landscapes, present in both BCC and melanoma. While independent mutations consistently reproduce canonical UV signatures (SBS7a–c) in both tumor types, collateral mutations tell a distinct and more varied narrative between BCC and melanoma. These collateral mutations are unusually abundant for non-UV characteristics, such as age-related SBS1 and SBS5, and display a notable 3′ to 5′ asymmetry near UV-induced lesions in pyrimidine dimers. We also demonstrated that BCC displays a pronounced enrichment of dinucleotide base substitutions flanking UV-signature sites on the 3′ side, particularly CA>TG and CG>TA changes. Ultimately, these topological patterns in both tumors indicate that a primary photoproduct seeds secondary mutagenesis within its local chromatin environment, dramatically altering our understanding of UV-induced lesion processing. Full article

Background/Objectives: Skin cancer is a major health concern worldwide and has led to the quest for safer and more effective topical chemopreventive agents. In this study, the in vivo efficacy of a hydrogel formulation containing kaempferol and ferulic acid-loaded nanoparticles was evaluated for the management of DMBA-croton oil-induced skin cancer in Swiss albino mice. Methods: Drug-loaded nanoparticles prepared via nanoprecipitation were incorporated into hyaluronic acid to obtain single-drug (FAPG, KMPG) and dual-drug-loaded (FKMG) hydrogel formulations. Skin tumors were induced via DMBA as an initiator followed by croton oil as a promoter, with tumor onset observed after a similar latency period of approximately 5–6 weeks in all carcinogen-exposed groups. Treatment was initiated after week 6 and continued until week 16. Results: The gel formulation had a skin-compatible pH and the desired rheological and spreadability properties. The dual drug-loaded hydrogel formulation had a more controlled and prolonged release profile. Compared with the negative and vehicle control groups, the FKMG-treated group presented a marked reduction in tumor incidence and tumor burden, along with improved body weight gain. Biochemical analysis revealed the restoration of antioxidant and enzyme activity in treated animals, particularly in animals treated with FKMG. Histopathological examination revealed near-normal skin architecture in FKMG-treated mice, indicating strong protective effects. Additionally, significant downregulation of TNF-α and IL-6 suggested effective suppression of tumor-promoting inflammatory pathways. Conclusions: Overall, the FKMG formulation exhibited superior chemopreventive efficacy compared with the FAPG and KMPG treatments, highlighting its potential as a promising topical therapeutic strategy against chemically induced skin carcinogenesis. Full article

Ultraviolet B (UVB) radiation is a primary cause of DNA damage in the skin, which is often a precursor to skin cancer. Natural products represent a rich source of compounds with unexplored photoprotective properties. Our previous work identified 3-methoxybenzyl isothiocyanate (MBITC), a meadowfoam derivative, as a promising UVB-absorptive agent that reduces DNA damage and cell proliferation; however, its clinical use is limited by dose-dependent cytotoxicity. To address this, we synthesized a novel amide lipid conjugate of MBITC, N-(3-methoxybenzyl)eicos-5-enamide (MBA), and evaluated its photoprotective efficacy and mechanism of action. Our findings demonstrate that MBA exhibited remarkably reduced cytotoxicity compared to its parent compound, while effectively retaining its photoprotective properties. In human primary keratinocyte cultures, MBA significantly reduced UVB-induced DNA damage, as evidenced by a decrease in cyclobutane pyrimidine dimers (p < 0.05) and γ-H2A.X (p < 0.05). Furthermore, MBA increased the expression of DNA damage response (DDR) proteins and DNA damage-binding protein 1 (DDB1) (p < 0.05) and the activation of Ataxia Telangiectasia and Rad3-related protein (ATR) (p < 0.05), a master regulator of DDR and repair pathways. These findings suggest that MBA acts through direct UVB absorption and/or the engagement of DDR pathways following irradiation, highlighting its potential use as a novel photoprotective compound. Full article