"Stem Cell Science & Age Management of Skin" By: Christine Heathman for Skin Inc.

Editor’s Note: This article is based on a presentation that will be presented by the author at Face & Body Northern California, July 17–19, 2010, at the San Jose McEnery Convention Center in San Jose, California. To learn more about and register for this event, log on towww.FaceandBody.com/california. “The development of cell lines that may produce almost every tissue of the human body is an unprecedented scientific breakthrough. It is not too unrealistic to say that this research has the potential to revolutionize the practice of medicine, and improve the quality and length of life.” —Harold Varmus, Nobel Prize winner and former director, National Institutes of Health Fighting the skin-aging clock now requires more understanding of ingredient science and the anatomy, histology and physiology of the skin. Research in skin biology began charting an interdisciplinary approach to the skin sciences several decades ago, but the demand for anti-aging ingredients has driven the need for the progressive age management of skin to an all-time high. A recent study conducted by an independent survey reports more than 62% of women between the ages of 35–54, and more than 65% of women 55 and older, affirm that aging is their reason for using skin care products.1 It is unavoidable: Skin ages. The genetic answer to skin aging lies in the fact that each gene codes for a specific protein, and proteins determine how cells work. Proteins, such as collagen, provide bodily structure by connecting tissues and organs. In the case of skin, collagen acts as scaffolding holding up the skin, and keeping it smooth and wrinkle-free. Wrinkles are the benchmark of declining collagen levels and can affect all age groups when UV radiation assaults cells, breaking down DNA via the sun’s proton energy. The innate aging process is made worse via UV radiation, chemical compositions of tissue change, sun, pollution, heat, smoking, drugs, stress, diet and other environmental factors affecting the challenge of skin aging. Because of this, new revolutionary ingredients that combat chronological aging, reduce superficial and deep wrinkles, delay senescence of essential cells, and preserve the youthful appearance and vitality of skin have been discovered using the biotechnology of plant stem cell extracts. Plant stem cell extracts have been proven to protect skin from UV oxidative stress and inhibit inflammation; control UV-induced matrix metalloproteinase (MMP) activation, collagen loss and tissue damage; and combat destructive free radical injury that leads to photoaging.2 What are stem cells? Stem cells are unprogrammed cells that can differentiate into a cell with specific functions. They are related to longevity and have a unique growth characteristic allowing them to make identical copies of themselves, as well as differentiate to become specialized cells. Stem cells have the capacity to replenish themselves through self-renewal, and the ability to generate differentiated cells. Each cell, whether stem cell or differentiated cell, has the same DNA—or genes—but a stem cell’s characteristic depends on signals from the microenvironment, such as neighboring cells that form a function. Principally, there are signals inside each cell that control its fate called epigenetic signals. They are tags on the DNA or surrounding histone proteins regulating the switching on or off of genes. The most remarkable feature of cells is their ability to reproduce. Any cell is simply a compartment with a watery interior separated from the external environment by a surface membrane, which can be thought of as a plasma film, preventing the free flow of molecules in and out of the cell. The simplest type of reproduction entails the division of a parent cell into two daughter cells. This occurs as part of the cell cycle, a series of events that prepares a cell to divide followed by the actual division process, called mitosis. In single-cell organisms, both daughter cells often resemble the parent cell. In multicellular organisms, stem cells can give rise to two different cells: one that resembles the parent cell and one that does not. Stem cells and skin High-tech plant cell cultures have been harnessed to protect skin stem cells based on the science of botanical wound-healing. To understand how these ingredients function, it is important to understand the relationship of the stem cell population with other cells of the skin. The skin. The skin is the largest and most dynamic immune organ, made up of billions of cells playing a protective and esthetic role where aging is clinically evident via wrinkles. Two types of adult stem cells have been identified within the skin’s ecosystem: epithelial skin cells located in the basal layer of the epidermis, and hair bulge stem cells situated in the hair follicle. The skin’s top layer, the epidermis, is a stratified epithelium housing terminally differentiated cells that shed by the millions daily from the skin, continuously delivering new skin cells. Because of this differentiating cell dynamic, the importance of stem cells in the skin is scientifically substantiated, enumerating their relevance to skin age management. The role of the epidermis stems directly from the terminal differentiation of keratinocytes into corneocytes to form what is the visible skin. This dynamic and complicated immune organ interfaces with a hostile environment, and its uppermost layer, the stratum corneum, is subject to continuous abrasion by chemical and physical injury. The stratum corneum, an essential part of the epidermis, is the outermost skin layer at the environment interface. This skin layer is also the principal permeability barrier to transepidermal water loss (TEWL) and a major cordon to percutaneous absorption of topically applied compounds, such as botanical stem cell extracts. The degree of moisture in the stratum corneum is an important factor when evaluating skin function because loss of moisture is a major factor in aging skin. This detail is important to note when treating and managing photoaging skin because there is a significant correlation between TEWL and the percutaneous absorption of topical ingredients. Why is TEWL an important measurement in aging skin? Water in the stratum corneum is a dynamic equilibrium between the underlying tissues and the environmental atmosphere. The intricate stratum corneum barrier constitutes 70% of the epidermis, which is continuously rehabilitated from the granular layer. This layer is the first victim of UV assault that eventually results in photoaging of the skin. To protect the epidermis against invasion of microorganisms and toxic agents, as well as the loss of indigenous fluids residing in the stratum corneum, the horny layer of the skin must be perpetually renewed. This is where stem cells play an important role. Stem cells’ role in the skin. The stem cell, which is responsible for cell renewal replacement in the epidermis, is an intermediate between the keratinocyte stem cell and terminally differentiating cells. The stem cell is the amplifying cell that undergoes limited cycles of replication. One of the key questions in stem cell research has been how stem cells know when it’s time to stop reproducing. In some cases, stem cells seem to be able to divide into two structurally different cells; one that remains a stem cell and another, called a progenitor cell, that goes on to generate specialized cells. Details still remain unclear, so this area of research remains active, however the study with skin stem cells reveals important information about other organs of the body. Researchers believe certain proteins and other signaling or controlling molecules are responsible for directing cell specialization, however they are still actively working to identify the specific molecules that control normal skin development. Scientists recognize skin stem cells are the decision-makers that direct the production of new skin cells, as is evidenced by the daily shedding of dead stratum corneum epithelium.3 If skin stem cells did not preside over and create skin cell replacements, they certainly would suffer a fateful demise. Skin stem cells generate new skin to replace the cells lost every day and influence wound-healing. Skin begins with a single cell. One cell, dividing into two, then two into four and four into eight until there are billions of cells, patterned and diffuse, color-coded and clear, working-class and upper crust, ancient and young, defenders and helpers, assembled into a great, thriving mass that is a complete skin organ. And from this, millions drop from the skin daily and the replication process keeps new generations of cells in a replenishment course of action that can repeat itself more than 900 times during a life cycle of self-renewal. Cell lineage. The formation of working tissues during the development of multicellular organisms depends in part on specific patterns of mitotic cell division. A series of such cell divisions similar to a family tree is called cell lineage, which traces the progressive determination of cells, restricting their developmental potential and their differentiation into specialized cell types. Cell lineages are controlled by intrinsic factors—cells acting according to their history and internal regulators—as well as extrinsic factors such as cell-cell signals and environmental inputs. A cell lineage begins with stem cells. The stem cell name comes from the image of a plant stem, which grows upward, continuing to form more stems, while sending off leaves and branches to the side. The stem cell is as important to a differentiating skin cell as a branch is to a leaf. Healthy stem cells mean healthier, younger-acting skin. Stem cells and age management With current applications for treating and managing aging skin, scientists are focusing their research on adult stem cells located in the skin and are studying the potential of this cell type, coupled with its function related to chronological aging to help understand how the skin’s aging clock can be reset.2 Epidermal adult stem cells replenish and maintain the balance of cells within the skin tissue, and regenerate tissue caused by damage from a variety of sources, such as the sun, injury and acne. Age is the major adversary, and it diminishes the number of skin stem cells, making their ability to repair the skin less efficient. Plants have stem cells comparable to human stem cells. Unlike humans, plants contain totipotent stem cells with the potential to regenerate a whole plant. This action gives scientific rise to the benefits of the plant stem cells’ ability to regenerate new leaves, flowers, seeds or a whole, fresh plant. Unlike human stem cells, plant stem cells can de-differentiate and become a stem cell.2 The stem cell ingredient that has garnered much attention lately is the extract called Malus domestica, sourced from a rare Swiss apple identified as the Uttwiler Spatlauber. The Uttwiler Spatlauber apple is an endangered variety that is well-known for its excellent storability and longevity potential due to its long-living tissue stem cells. Fruit is known to oxidize quickly once removed from its primary host and exposed to the environment; however, this is not the case with the Uttwiler Spatlauber apple.2 It is an anomaly among fruit, resisting typical oxidation due to its high tannin content and long-living stem cells. In order to use the stem cells from this apple, scientists had to extract tissue from the plant to create cultures called explants. The explants are then scratched to create miniature wounds to stimulate the stem cells within the cultured plant tissue. This action induced the formation of new stem cells.2 Biotechnologies of plant stem cell extracts also isolate the substances involved in the plant’s defensive ability against environmental, physical and biological stressors. Scientists in Switzerland studied the liquid cell cultures derived from their extensive study of the Uttwiler Spatluber apple and have found that the stem cells extracted from it can stimulate human stem cell growth and protect skin stem cells from death due to UV overexposure, neutralizing free radicals and reversing the effects of photoaging of the skin. Other biotechnological research in botanical stem cell research is emerging quickly in professional skin care to benefit the management of aging skin.2 A revolutionary approach This is an exciting time to be in specialized skin care as a new approach to age management is becoming available through the use of stem cells. Professional age management of skin is all about extending and preserving the life energy of skin cells to help yield results for younger-acting skin. Current applications for treating aging skin will continue to lead scientists to focus their research on adult stem cells located in the skin, and the continued study of these cells, their function relating to aging and how they helps reset the skin’s aging clock, is groundbreaking and revolutionary. REFERENCES 1. www.SkinInc.com/treatments/facial/84014002.html (Accessed May 10, 2010) 2. C McKiver, Plant Stem Cells: A Cure for Aging?, Inside Cosmeceuticals (Aug 3, 2009) 3. R Barthel and D Aberdam, Epidermal stem cells, Journal of the European Academy of Dermatology & Venereology 19(4) 405–413 (2005)

Find this article at: http://www.skininc.com/skinscience/physiology/94947479.html

Copyright © 2008 Allured Publishing. All rights reserved.

Stress & Skin, brought to you by The American Academy of Dermatology

How the Mind Matters to Your Skin

How we feel on the inside could be affecting how we look on the outside. In fact, studies link factors that impact our emotional well-being — such as stress, depression and anxiety — to an increase in skin, hair or nail problems. Dermatologist and clinical psychologist Richard G. Fried, MD, PhD, FAAD, of Yardley, Pa., explains the reciprocal relationship between feelings and appearance:

Psychodermatology Interventions

• Stress can manifest itself on one's appearance in many ways, but primarily by making the skin more sensitive and more reactive.
  • For example, stress can make psoriasis or rosacea worse, result in acne lesions that are more inflamed and more persistent, cause brittle nails and ridging of the nails, cause hair loss, cause or worsen hives, and cause excessive perspiration.
  • Stress also is a known trigger or can be a worsening factor for fever blisters, psoriasis, seborrheic dermatitis and has even been shown to impair skin barrier function and dehydrate the skin — allowing more irritants, allergens, and infectious agents to penetrate the skin and cause problems.
• Beyond the direct physiological effects of stress, patients under stress also tend to neglect or abuse their skin. For example, they often lack the energy and motivation to adhere to their skin care regimens, and there also might be signs of stress-related behaviors — such as scratching, pulling or rubbing — that can exacerbate problems.
• Traditional dermatologic therapies should be used in conjunction with appropriate stress management therapies to successfully treat stress-related dermatologic conditions.
  • When dermatologists treat both the skin and stress, the skin often clears more quickly and completely as the influences of stress are diminished. This, in turn, can help decrease a patient's overall anxiety level, and the patient may start to feel better about how they look and how they feel emotionally.
• On a microscopic level, stress reduction can decrease the release of pro-inflammatory stress hormones and chemicals. For example, release of neuropeptides (or stress chemicals released from the nerve endings) can be reduced with stress management techniques. This often results in skin that looks and functions better.
  • These interventions can reduce blood vessel over-activity, resulting in less blushing or flushing.
• With accurate diagnosis by a dermatologist, effective treatments improve the appearance and function of the skin. This alone can substantially reduce patients' stress and improve their skin, hair and nail conditions. However, if stress is clearly interfering with patients' overall well-being and ability to cope, simultaneous stress management interventions are warranted. In some instances, referral to a mental health professional may be necessary.

Cosmetic Interventions

• While skin rejuvenation procedures have been shown to significantly improve a person's outward appearance, studies suggest these types of cosmetic interventions also can have positive effects on how people feel and how they function.
  • When people feel more attractive and more confident in their appearance, they tend to perform better in other areas of their lives — in their work, family life, social life, and marriage or personal relationships.
  • Under the right circumstances, cosmetic procedures can be a powerful ally, but it's important for patients to understand that these procedures are not a panacea.
• In a 2008 study designed to measure the positive ripple effects of botulinum toxin injections on other aspects of patients' lives, Dr. Fried found that patients treated with botulinum toxin clearly experienced substantial benefits. His key findings include:
  • 29 percent reported feeling less anxious
  • 36 percent said they feel more relaxed
  • 49 percent were more optimistic
• A previous study conducted by Dr. Fried evaluating the clinical and psychological effects of the use of alpha hydroxy acids (AHAs) found that patients demonstrated significant improvements in facial skin tone and fine wrinkling, and reported satisfaction with their physical appearance and the quality of their interpersonal relationships.

For more information on the effects of stress on skin, hair and nails, visit the American Academy of Dermatology's website at www.aad.org.

November 2008

What is used in the Iderm Treatment?

The Iderm Treatment

To prep the skin I start with a process called a Moisture Pack where I place pieces of fabric that have been soaked in Dermaculture’s Yucca Solution. This solution is derived from the Yucca plants of the southwestern desert, and is an excellent facial cleanser and is also anti-inflammatory. After placing the fabric on the face I then cover the face with an infrared heat dome or "dry heat" for about 10 minutes.

Yucca is high in vitamins A, B and C and contains potassium, calcium, phosphorus, iron, manganese and copper which make it very soothing to the skin, bones and muscles.
The ingredients are over 95% Yucca with stabilizers.

This treatment helps to cleanse the walls of the pores, making it ideal in preparing the skin for extractions.

After extractions I then wrap the skin with cotton and fabric that has been soaking in Dermaculture’s Positive Solution.

This is used to treat acne, age spots, rosacea and psoriasis. This will also give a more youthful glow to the skin, and is beneficial to all skin types.

The Positive Solution is made from a perfect balance of zinc sulfate (Zinc sulfate is used to destroy harmful micro-organisms on the skin and also for its astringent action), citric acid (Vitamin C) and epson salts. The ingredients are very rich in vitamins and minerals. These ingredients work together to increase oxygen, hydration and circulation. The solution is antibacterial and aids in detoxification. It promotes healing, stimulates skin renewal and collagen growth.

The Iderm Treatment is highly recommended before surgical procedures to help prepare the skin for surgery and after surgery to help with the healing process and to prevent scarring.

For more information about this awesome skin treatment visit my website at www.dermaspace.com.

Skin Cancer Facts

Skin Cancer Facts – provided by The Skin Cancer Foundation

GENERAL

• Skin cancer is the most common form of cancer in the United States. More than 3.5 million cases in two million people are diagnosed annually.³⁷
• Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.³
• One in five Americans will develop skin cancer in the course of a lifetime.²⁶
• Basal cell carcinoma (BCC) is the most common form of skin cancer; an estimated 2.8 million BCCs are diagnosed annually in the US.³⁸ BCCs are rarely fatal, but can be highly disfiguring if allowed to grow.
• Squamous cell carcinoma (SCC) is the second most common form of skin cancer. An estimated 700,000 cases are diagnosed each year in the US,³⁹resulting in approximately 2,500 deaths.²
• Basal cell carcinoma and squamous cell carcinoma are the two major forms of non-melanoma skin cancer. Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.⁷
• In 2004, the total direct cost associated with the treatment for non-melanoma skin cancers was more than $1 billion.¹⁴
• About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.³⁰
• Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun.¹⁶
• Contrary to popular belief, 80 percent of a person's lifetime sun exposure is not acquired before age 18; only about 23 percent of lifetime exposure occurs by age 18.⁸

Lifetime UV Exposure in the United States
Ages	Average Accumulated Exposure*
1-18	22.73 percent
19-40	46.53 percent
41-59	73.7 percent
60-78	100 percent

*Based on a 78 year lifespan

MELANOMA

• The vast majority of mutations found in melanoma are caused by ultraviolet radiation.³⁶
• The incidence of many common cancers is falling, but the incidence of melanoma continues to rise significantly, at a rate faster than that of any of the seven most common cancers.²¹
• Approximately 68,720 melanomas will be diagnosed this year, with nearly 8,650 resulting in death.³
• Melanoma accounts for about three percent of skin cancer cases,³¹ but it causes more than 75 percent of skin cancer deaths.³²
• Melanoma mortality increased by about 33 percent from 1975-90, but has remained relatively stable since 1990.²¹
• Survival with melanoma increased from 49 percent between 1950 and 1954 to 92 percent between 1996 and 2003.²¹
• More than 20 Americans die each day from skin cancer, primarily melanoma. One person dies of melanoma almost every hour (every 62 minutes).³
• The survival rate for patients whose melanoma is detected early, before the tumor has penetrated the epidermis, is about 99 percent.³⁴ The survival rate falls to 15 percent for those with advanced disease.³
• Melanoma is the fifth most common cancer for males and sixth most common for females.³
• Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.³
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.¹⁸
• About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.³⁰
• One in 55 people will be diagnosed with melanoma during their lifetime.¹⁹
• One blistering sunburn in childhood or adolescence more than doubles a person's chances of developing melanoma later in life.⁴
• A person's risk for melanoma doubles if he or she has had five or more sunburns at any age.⁵

MEN / WOMEN

• The majority of people diagnosed with melanoma are white men over age 50.¹⁹
• Five percent of all cancers in men are melanomas; Four percent of all cancers in women are melanomas.³
• Contrary to popular belief, recent studies show that people receive a fairly consistent dose of ultraviolet radiation over their entire lifetime. Adults over age 40, especially men, have the highest annual exposure to UV.⁸
• Between 1980 and 2004, the annual incidence of melanoma among young women increased by 50 percent, from 9.4 cases to 13.9 cases per 100,000 women.³⁵
• The number of women under age 40 diagnosed with basal cell carcinoma has more than doubled in the last 30 years; the squamous cell carcinoma rate for women has also increased significantly.⁹
• Until age 39, women are almost twice as likely to develop melanoma as men. Starting at age 40, melanoma incidence in men exceeds incidence in women, and this trend becomes more pronounced with each decade.¹⁷
• One in 39 men and one in 58 women will develop melanoma in their lifetime.³
• Melanoma is one of only three cancers with an increasing mortality rate for men.¹⁷

INDOOR TANNING

• Ultraviolet radiation (UVR) is a proven human carcinogen, according to the U.S. Department of Health and Human Services.¹⁰
• Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.¹⁰
• Nearly 30 million people tan indoors in the U.S. every year¹²; 2.3 million of them are teens.¹⁵
• On an average day, more than one million Americans use tanning salons.²²
• Seventy one percent of tanning salon patrons are girls and women aged 16-29.¹³
• First exposure to tanning beds in youth increases melanoma risk by 75 percent.¹¹
• People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.²⁰
• The indoor tanning industry has an annual estimated revenue of $5 billion.¹⁵

PEDIATRICS

• Melanoma accounts for up to three percent of all pediatric cancers.²⁴
• Between 1973 and 2001, melanoma incidence in those under 20 rose 2.9 percent.²⁸
• Melanoma is seven times more common between the ages of 10 and 20 than it is between 0 and 10 years.²³
• Diagnoses - and treatment - are delayed in 40 percent of childhood melanoma cases.²⁴
• Ninety percent of pediatric melanoma cases occur in girls aged 10-19.²³

ETHNICITY

• Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.⁶
• The average annual melanoma rate among Caucasians is about 22 cases per 100,000 people. In comparison, African Americans have an incidence of one case per 100,000 people. However, the overall melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.²¹
• While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.⁶
• Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.²⁵
• Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese, and Japanese, and other Asian populations.²⁵
• Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians. ²⁵
• Among non-Caucasians, melanoma is a higher risk for children than adults: 6.5 percent of pediatric melanomas occur in non-Caucasians.²³

Sources

1. "Squamous Cell Carcinoma." MayoClinic.com. 8 March 2007. 15 April 2008. Link.

2. "Squamous Cell Carcinoma." American Academy of Dermatology. 15 April 2008.Link.

3. American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.

4. Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Oncol, 1983; 12:981-6.

5. Pfahlberg A, Kolmel KF, Gefeller O. Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. British Journal of Dermatology, March 2001; 144; 3:471.

6. Cress RD, Holly EA. Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93.Cancer Causes Control 1997; 8:246-52.

7. "Sun Protection." National Cancer Institute's Cancer Trends Progress Report - 2007 Update. 15 April 2008. Link.

8. Godar DE, Urbach F, Gasparro FP, van der Leun JC. UV Doses of Young Adults.Photochemistry and Photobiology, 2003, 77(4): 453-457.

9. Christenson LJ, Borrowman TA, Vachon CM, Tollefson MM, Otley CC, Weaver AL, Roenigk RK. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA. 2005;294:681-690.

10. "11th ROC: Ultraviolet Radiation Related Exposures." 27 January 2005. U.S. Department of Health & Human Services. 15 April 2008. Link.

11. The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: Asystematic review.International Journal of Cancer 2006; 120:1116-1122.

12. Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE. Promotion of frequent tanning sessions by indoor tanning facilities: two studies. J Am Acad Dermatol 2003; 46:700-5.

13. Swerdlow AJ, Weinstock MA. Do tanning lamps cause melanoma? An epidemiologic assessment. J Am Acad Dermatol 1998; 38:89-98.

14. Bickers DR, Lim HW, Margolis D et al. The burden of skin diseases: 2004. J Am Acad Dermatol. 2006; 55: 490-500.

15. Demierre MF. Time for the national legislation of indoor tanning to protect minors.Arch Dermatol 2006; 139:520-4.

16. Taylor CR et al. "Photoaging/Photodamage and Photoprotection" J. of American Academy of Dermatology, 1990: 22

17. Ahmedin Jemal, Rebecca Siegel, Elizabeth Ward, Taylor Murray, Youngping Hao, Jiaquan Xu, and Michael J. Thun. Cancer Statistics, 2008. CA Cancer J Clin 2008 58: 76.

18. Cancer Epidemiology in Older Adolescents & Young Adults. SEER AYA Monograph Pages 53-63. 2007.

19. Melanoma of the Skin, Cancer Fact Sheets, National Cancer Institute, SEER Database, 2008. Link.

20. Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, and Weinstock MA. Use of Tanning Devices and Risk of Basal Cell and Squamous Cell Skin Cancers. J. Natl. Cancer Inst. 2002 94: 224; doi:10.1093/jnci/94.3.224

21. SEER Cancer Statistics Review, 1975-2004 (NCI) Link.

22. Spencer JM, Amonette RA. Indoor tanning: Risks, benefits, and future trends. J AM Acad Dermatol 1995; 33:288-98.

23. Lange JR., Palis BE, Chang DC, Soong S, Balch CM. Melanoma in Children and Teenagers: An Analysis of Patients From the National Cancer Data Base. J. Clin. Oncol.2007; 25:1363-8.

24. Ferrari A, Bono A, Baldi M, et al. Does Melanoma Behave Differently in Younger Children Than in Adults? A Retrospective Study of 33 Cases of Childhood Melanoma From a Single Institution. Pediatrics. 2005; 115:649-57.

25. Gloster HM, Neal K. Skin Cancer in Skin of Color. J Am Acad Dermatol 2006; 55:741-60.

26. Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: 1541-43.

27. Elwood JM, Jopson J. Melanoma and Sun Exposure: An Overview of Published Studies. Int J Cancer. 1997; 73: 198-203.

28. Strous JJ, Fears TR, Tucker MA, Wayne AS. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol 2005; 23:4735-41.

29. "What is Squamous and Basal Cell Skin Cancer?" American Cancer Society. 5 May 2008. Link.

30. Armstrong, B.K., and A. Kricker, How much melanoma is caused by sun exposure?,Melanoma Research, 1993: 3:395-401.

31. "How Many People Get Melanoma Skin Cancer?" American Cancer Society. 13 May 2008. Link.

32. "The Burden of Skin Cancer." National Center for Chronic Disease Prevention and Health Promotion. 13 May 2008. Link.

33. Conti EM, Cercato MC, Gatta G, et al. Childhood Melanoma in Europe since 1978: a population-based survival study. Eur J Canc 2001; 37:780-4.

34. Huang CL, Halpern AC. Management of the patient with melanoma. In: Rigel DS, Friedman RJ, Dzubow LM, Reintgen DS, Bystryn J-C, Marks R, eds. Cancer of the Skin. New York, NY: Elsevier Saunders; 2005:265-75.

35. Perdue, Mark. Increase in melanoma cases among young American women. J Investigative Dermatology 2008.

36. Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue of somatic mutations from a human cancer genome. Nature 2009.

37. Howard W. Rogers, MD, PhD, Martin A. Weinstock, MD, PhD, et al. Incidence Estimate of Nonmelanoma Skin Cancer in the United States, 2006. Archives of Dermatology 2010.

38. Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to Mark Teich. March 31, 2010.

39. Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to Mark Teich. April 1, 2010.

These facts and statistics have been reviewed by

David Polsky, MD, Assistant Professor of Dermatology and Pathology, New York University Medical Center

and

Steven Q. Wang, MD, Director of Dermatologic Surgery and Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ.