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In Canada, more than 80,000 cases of skin cancer are diagnosed every year. Because exposure to ultraviolet radiation is estimated to be associated with 80%-90% of skin cancers, the use of sunscreen--which blocks ultraviolet radiation--is promoted as an important means of preventing skin cancers, as well as sunburn and skin photoaging. Here, Sander et al discuss evidence related to the effectiveness and harms of sunscreen to help physicians counsel their patients.

A 40-year-old woman was presented to a dermatology clinic for assessment of new nevi surrounded by depigmented skin, as well as separate depigmented patches, which had appeared suddenly within 1 month of SARS-CoV-2 infection in 2021. She reported a history of multiple nevi since childhood but no history of halo nevi, vitiligo, or malignancy. She was otherwise healthy, took no regular medications, and had no relevant family history. She had recently had an ophthalmological examination that was normal. Full-body skin examination revealed 10 intradermal nevi with surrounding depigmented round patches, consistent with halo nevi. On the right shoulder, left anterior hip, and forehead, she had well-defined depigmented patches, consistent with vitiligo. They performed dermoscopy, and her nevi appeared benign, demonstrating a regular reticular pattern with no atypical features. As she was not bothered cosmetically by her vitiligo, they did not pursue treatment, but we arranged a 1-year follow-up appointment to monitor for cutaneous melanoma.

Sucking pads are benign, self-limiting skin findings that develop on the red lip in infants as a result of repetitive suction and pressure during feeding. Although well described in pediatric dermatology, documentation of these lesions in infants with skin of color is limited, which may cause diagnostic uncertainty. We present a case of a 41-day-old infant with skin phototype V and a 2-week history of progressive fixed darkening and mild scaling of the lips. The mucosal areas were spared and there was no evidence of central cyanosis, clinically consistent with sucking pads. This case highlights the importance of recognizing sucking pads as a cause of lip dyspigmentation in infants across all skin phototypes and understanding normal physiologic variations among diverse populations. Increased representation of pediatric skin of color in educational resources is critical to ensure equitable and accurate clinical assessment.

Secukinumab was the first fully human anti-interleukin-17a monoclonal antibody and successfully treated moderate-severe psoriasis. These new, targeted, medications are becoming more ubiquitous, but long-term side effects are not fully known. Post-market surveillance is crucial to identify delayed adverse events, analogous to the paradoxical development of pustular psoriasis in a subset of patients treated with the anti-tumor necrosis factor-alpha class drugs. Dyshidrotic eczema and pompholyx are rare variants of dermatitis characterized by vesicles or bullae on the palms, soles and sides of the fingers. The etiology of dyshidrotic eczema is not always known, but medications have been implicated in a minority of patients. Herein, we present two cases of dyshidrotic eczema developing in patients on secukinumab for psoriasis. Extended follow-up and larger numbers of patients are needed to fully understand the potential association between secukinumab and dyshidrotic eczema.

Background Patients with treated solid tumours (TSTs) are a highly heterogeneous population at an increased risk for malignancy compared with the general population. When treating psoriasis in patients with a history of TSTs, clinicians are concerned about the immunosuppressive nature of psoriasis therapies, the possibility of augmenting cancer recurrence/progression, and infectious complications. No direct, high-level evidence exists to address these concerns. Objectives We aim to provide a structured framework supporting healthcare professional and patient discussions on the risks and benefits of systemic psoriasis therapy in patients with previously TSTs. Our goal was to address the clinically important question, “In patients with TSTs, does therapy with systemic agents used for psoriasis increase the risk of malignancy or malignancy recurrence?” Methods We implemented an inference-based approach relying on indirect evidence when direct clinical trial and real-world data were absent. We reviewed indirect evidence supporting inferences on the status of immune function in patients with TSTs. Recommendations on systemic psoriasis therapies in patients with TSTs were derived using an inferential heuristic. Results We identified five indirect indicators of iatrogenic immunosuppression informed by largely independent bodies of evidence: (1) overall survival, (2) rate of malignancies with psoriasis and systemic psoriasis therapies, (3) rate of infections with psoriasis and systemic psoriasis therapies, (4) common disease biochemical pathways for solid tumours and systemic psoriasis therapies, and (5) solid organ transplant outcomes. On the basis of review of the totality of this data, we provided inference-based conclusions and ascribed level of support for each statement. Conclusions Prior to considering new therapies for psoriasis, an understanding of cancer prognosis should be addressed. Patients with TSTs and a good cancer prognosis will have similar outcomes to non-TST patients when treated with systemic psoriasis therapies. For patients with TSTs and a poor cancer prognosis, the quality-of-life benefits of treating psoriasis may outweigh the theoretical risks. Plain Language Summary Patients with previously treated cancer have a higher chance of cancer recurrence compared with the general population. With cancer incidence rising worldwide, doctors across medical specialities will need to treat other medical conditions, including inflammatory diseases such as psoriasis, in these patients. Effective systemic therapies for psoriasis reduce immune cell activity. Accordingly, there are concerns that treatments for psoriasis could worsen cancer recurrence/progression and infectious complications. There is not enough quality evidence to make broad recommendations for treating other inflammatory conditions in patients with a history of cancer. To guide patient and doctor discussions, we asked: what are effective and safe treatments when patients with treated solid tumours need systemic therapy (pills or injections) for their psoriasis? We focused on patients with solid tumours and excluded blood and skin cancers. Our panel of experts, including 12 dermatologists and 3 medical oncologists, reviewed direct and indirect evidence to answer this question. Considering the totality of evidence reviewed, the expert panel drafted and rated their level of support for opinion statements on important considerations in treating patients with psoriasis who have a history of solid tumours. By making inferences on systemic psoriasis therapies in this heterogeneous population, we take the onus off individual physicians to review the indirect data. This process may help answer questions in other disease populations where direct evidence is scarce or absent. To support treatment decisions, doctors should have a guided conversation with the patient and their family on a case-by-case basis about the risks and benefits of treatment.

The sun protection factor (SPF) measures protection mainly from ultraviolet (UV) B. However, increasing evidence incriminates UVA in the pathogenesis of skin cancer.1 The World Health Organization classifies both UVA and UVB as Group 1 carcinogens.1 In addition to looking for sunscreens with an SPF of at least 30 (for UVB), patients should look for products that are labelled as \"broad spectrum\" and have the UVA logo circled, which means they meet Health Canada's requirements for UVA protection. Studies show that zinc oxide and titanium dioxide nanoparticles in sunscreens do not penetrate past the level of the stratum corneum (the outermost \"dead\" layer of skin cells) after topical application to intact skin.5 Health Canada has approved multiple chemical sunscreens and the physical agents zinc oxide and titanium dioxide. 6 A highly publicized study of rats fed large doses of oxybenzone (a chemical sunscreen) created controversy over its safety; however, a mathematical model showed that it would be essentially impossible for humans to attain the systemic levels in the study from topical application of oxybenzone.7 Patients with concerns about chemical sunscreens can use physical sunscreens; avoidance of sun exposure and wearing sunprotective clothing are considered first-line protection strategies for prevention of skin cancer.