From Biomarkers to Molecular Epidemiology

1. For primary prevention of skin cancer, it becomes more and more evident in the last years that integrated approaches combining behavioral prevention (changes in behavior to reduce personal ultraviolet (UV) exposure) and structural prevention (e.g. creating shade, reducing heat) are needed, in order to change behaviors and reduce UV exposure in population. EUROSKIN recommends a close collaboration between public health experts, behavioral scientists, communication experts, climate specialists, basic scientists, architects, city planners and regulatory bodies.
2. Biomarkers can play an important role in early characterizing risk factors, diagnostics and disease progression of skin cancer.
   Recent studies showed that promising skin cancer and UV exposure biomarkers can be found (very stable) in body fluids like blood, plasma, cerebrospinal fluid, urine, etc. (e.g. circulating miRNAs) which further increases their potential to be used in primary and secondary prevention.
   EUROSKIN, therefore, recommends strengthening scientific efforts on biomarkers which can be used in skin cancer prevention. However, this should not only increase the number of detected candidate biomarkers but should also include translational research which validates the usefulness of these biomarkers in clinical or interventional settings.
3. A final version of a 2nd Scientific Opinion: “Biological effects of ultraviolet radiation relevant to health with particular reference to sunbed use for cosmetic purposes”, which has been requested by the European Commission, DG Health and Food Safety, Scientific Committee on Health and Environmental Risks (SCHEER), has recently been published (end of Nov. 2016) in the internet:
   (http://ec.europa.eu/health/scientific_committees/scheer/docs/scheer_o_003.pdf).
   
   The opinion, which has been formulated together with a scientific justification, comes to the following overall conclusion:
   
   UVR, including UVR emitted by sunbeds, is a complete carcinogen acting as both an initiator, through genotoxicity, and a promoter e.g. through immunosuppression. UV is a compete carcinogen. There is strong evidence that sunbed exposure causes skin melanoma, squamous cell carcinoma at all ages and that the risk for skin cancer is higher when the first exposure takes place in younger ages, and, to a lesser extent, basal cell carcinoma.
   
   Furthermore:
   - There is no need to use sunbeds to induce vitamin D.
   - There are no indications for threshold levels of UV-irradiance and UV-dose.
   - There is no safe limit for UV irradiance from sunbeds.
   - There are potential beneficial effects of UVR exposure from sunbeds (vitamin D
      synthesis). However, these are outweighed by the adverse effects and there
      is no need to use sunbeds to induce Vitamin D production.
      EUROSKIN fully supports the overall conclusion as well as its scientific
      justification which has been given on about 100 pages in the Opinion.
4. In the session about secondary prevention the effectiveness of skin cancer screening, including malignant melanoma, squamous cell carcinoma and basal cell carcinoma, was discussed and the need of education and training, to increase the effectiveness of the screening measurement, highlighted.
   EUROSKIN strongly recommends empowering of education and training of health professionals in the field of secondary prevention. Furthermore, in addition to evaluation of mortality reduction from skin cancer screening, intermediate endpoints, such as morbidity or quality of life, should be evaluated to assess the effectiveness of skin cancer screening.
5. In a last session, new communication concepts in skin cancer prevention were discussed as well as the difficulties to evaluate the effectiveness of primary prevention concepts.
   EUROSKIN recommends that evaluation schemes should always be included in the design of any intervention project. Furthermore, it is recommended to strengthen research which evaluates the actual need for information in the public, the kind of information which is considered useful by the public and the willingness in the public to accept more information.