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in people who intentionally expose themselves to sunlight&#44; sunscreen use delays the onset of burns and&#44; therefore&#44; increases the duration of exposure to UVR&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; both the mechanism by which UVR induces melanoma and the role of sunscreen use in preventing the disease has&#44; for decades&#44; remained unclear&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The journal <span class="elsevierStyleItalic">Nature</span> recently published a fascinating study carried out by a group of British researchers who investigated the effect of UVR on melanomagenesis in a mouse model expressing BRAF &#40;V600E&#41; in melanocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> They used conditional knockout mice &#40;genetically engineered using the Cre-loxP system&#41;&#59; the mice carried the mutated BRAF V600E gene but its expression was suppressed until activated&#46; It is possible&#44; using Cre-LoxP technology&#44; to repress the normal gene and activate the expression of the mutated gene at a specific point in the study&#46; The Cre protein is an enzyme&#44; and its expression can be induced by several different substances&#44; including tetracycline and tamoxifen&#46; Topical application of tamoxifen to the shaved back of the animal induced the expression of the BRAF V600E mutation only in the area where the activating substance was applied&#46; One month later&#44; half of the area in which the mutated gene had been activated was covered with a fabric opaque to UVR and the unprotected half of the back was exposed weekly for 6 months to UV-A or UV-B radiation &#40;160<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">&#8722;2</span>&#41; from a broad spectrum lamp&#46; To investigate the effect of sunscreen in preventing melanoma the investigators applied an FDA-recommended&#44; broad-spectrum &#40;UV-B or UV-A&#41; sunscreen product with an SPF of 50 &#40;2&#46;2&#160;mg&#47;cm<span class="elsevierStyleSup">&#8722;2</span>&#41;&#44; 30<span class="elsevierStyleHsp" style=""></span>min before exposure to UVR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The authors of the study made several observations of great interest and clinical significance&#46; First&#44; these low doses of UVR &#40;which induced mild erythema&#41; induced an increase in the size and development of new nevi only in the areas of skin with the BRAF mutation&#59; this phenomenon was not observed in the areas without mutation&#46; Second&#44; all the mice with the BRAF mutation exposed to UVR developed melanomas&#44; while the same exposure of skin without the mutation produced no increase in melanoma incidence&#44; indicating that UVR accelerates the BRAF-driven melanomagenesis process&#46; Another finding of great significance was that the application of sunscreen blocks the short-term effects of UVR &#40;induction of <span class="elsevierStyleItalic">Trp53</span>&#44; apoptosis of epidermal keratinocytes&#44; epidermal hypertrophy&#44; and thickening of the dermis&#41;&#59; however&#44; in mice carrying the BRAF mutation&#44; it delayed rather than completely prevented the development of melanoma&#46; In addition&#44; the authors demonstrated that topical application of the sunscreen reduces&#44; but does not completely eliminate&#44; the DNA damage induced by UVR&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; the study cited has demonstrated that the <span class="elsevierStyleItalic">TP53&#47;Trp53</span> mutations induced by UVR accelerate the process of BRAF-driven melanomagenesis&#46; Furthermore&#44; the results support the use of other photoprotection strategies in addition to sunscreen in at risk individuals who carry the BRAF mutation&#46;</p></span>"
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Resident's Forum
Do Sunscreens Eliminate the Risk of Melanoma?
FR ¿El uso de fotoprotectores elimina el riesgo de desarrollar melanoma?
I. Pastushenkoa,
Autor para correspondencia
jane.pastushenko@gmail.com

Corresponding author.
, Y. Gilaberte-Calzadab
a Interdisciplinary Research Institute (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
b Servicio de Dermatología, Hospital San Jorge, Huesca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Exposure to ultraviolet radiation &#40;UVR&#41; is the leading risk factor for developing cutaneous melanoma and the only modifiable factor known to date&#46; Multiple mutations linked to melanoma have also been reported&#44; the most common somatic mutation being a V600E substitution in BRAF&#46; The main sources of UVR exposure are sunlight and tanning booths&#46; As early as the 1980s&#44; numerous epidemiological studies had found a strong association between a history of sunburn and the risk of developing skin cancer&#46; Surprisingly however&#44; and contrary to what one might expect given the results of laboratory experiments&#44; several population studies have linked the use of sunscreens with an increased risk of developing melanoma<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and with a higher number of melanocytic nevi in children and adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> One explanation for these seemingly contradictory findings could be that&#44; in people who intentionally expose themselves to sunlight&#44; sunscreen use delays the onset of burns and&#44; therefore&#44; increases the duration of exposure to UVR&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; both the mechanism by which UVR induces melanoma and the role of sunscreen use in preventing the disease has&#44; for decades&#44; remained unclear&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The journal <span class="elsevierStyleItalic">Nature</span> recently published a fascinating study carried out by a group of British researchers who investigated the effect of UVR on melanomagenesis in a mouse model expressing BRAF &#40;V600E&#41; in melanocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> They used conditional knockout mice &#40;genetically engineered using the Cre-loxP system&#41;&#59; the mice carried the mutated BRAF V600E gene but its expression was suppressed until activated&#46; It is possible&#44; using Cre-LoxP technology&#44; to repress the normal gene and activate the expression of the mutated gene at a specific point in the study&#46; The Cre protein is an enzyme&#44; and its expression can be induced by several different substances&#44; including tetracycline and tamoxifen&#46; Topical application of tamoxifen to the shaved back of the animal induced the expression of the BRAF V600E mutation only in the area where the activating substance was applied&#46; One month later&#44; half of the area in which the mutated gene had been activated was covered with a fabric opaque to UVR and the unprotected half of the back was exposed weekly for 6 months to UV-A or UV-B radiation &#40;160<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">&#8722;2</span>&#41; from a broad spectrum lamp&#46; To investigate the effect of sunscreen in preventing melanoma the investigators applied an FDA-recommended&#44; broad-spectrum &#40;UV-B or UV-A&#41; sunscreen product with an SPF of 50 &#40;2&#46;2&#160;mg&#47;cm<span class="elsevierStyleSup">&#8722;2</span>&#41;&#44; 30<span class="elsevierStyleHsp" style=""></span>min before exposure to UVR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The authors of the study made several observations of great interest and clinical significance&#46; First&#44; these low doses of UVR &#40;which induced mild erythema&#41; induced an increase in the size and development of new nevi only in the areas of skin with the BRAF mutation&#59; this phenomenon was not observed in the areas without mutation&#46; Second&#44; all the mice with the BRAF mutation exposed to UVR developed melanomas&#44; while the same exposure of skin without the mutation produced no increase in melanoma incidence&#44; indicating that UVR accelerates the BRAF-driven melanomagenesis process&#46; Another finding of great significance was that the application of sunscreen blocks the short-term effects of UVR &#40;induction of <span class="elsevierStyleItalic">Trp53</span>&#44; apoptosis of epidermal keratinocytes&#44; epidermal hypertrophy&#44; and thickening of the dermis&#41;&#59; however&#44; in mice carrying the BRAF mutation&#44; it delayed rather than completely prevented the development of melanoma&#46; In addition&#44; the authors demonstrated that topical application of the sunscreen reduces&#44; but does not completely eliminate&#44; the DNA damage induced by UVR&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; the study cited has demonstrated that the <span class="elsevierStyleItalic">TP53&#47;Trp53</span> mutations induced by UVR accelerate the process of BRAF-driven melanomagenesis&#46; Furthermore&#44; the results support the use of other photoprotection strategies in addition to sunscreen in at risk individuals who carry the BRAF mutation&#46;</p></span>"
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    "fechaRecibido" => "2014-11-13"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pastushenko I&#44; Gilaberte-Calzada Y&#46; Do Sunscreens Eliminate the Risk of Melanoma&#63;&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;837&#8211;838&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of the experimental study design used by Viros et al&#46; UVR indicates utraviolet radiation&#46;</p>"
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                      "titulo" => "Sunscreen abuse for intentional sun exposure"
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                          "autores" => array:1 [
                            0 => "P&#46; Autier"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2009.09448.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2009"
                        "volumen" => "161"
                        "numero" => "Suppl 3"
                        "paginaInicial" => "40"
                        "paginaFinal" => "45"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of sunscreen and clothing on the number of melanocytic nevi in 1&#44;812 German children attending day care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Bauer"
                            1 => "P&#46; Buttner"
                            2 => "T&#46;S&#46; Wiecker"
                            3 => "H&#46; Luther"
                            4 => "C&#46; Garbe"
                          ]
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                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1093/aje/kwi086"
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                        "fecha" => "2009"
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                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sunscreen use and increased duration of intentional sun exposure&#58; Still a burning issue"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Autier"
                            1 => "M&#46; Boniol"
                            2 => "J&#46;F&#46; Dor&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ijc.22745"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cancer"
                        "fecha" => "2007"
                        "volumen" => "121"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17415716"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultraviolet radiation accelerates BRAF-driven melanomagenesis by targeting TP53"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Viros"
                            1 => "B&#46; Sanchez-Loarden"
                            2 => "M&#46; Pedersen"
                            3 => "S&#46;J&#46; Furney"
                            4 => "J&#46; Rae"
                            5 => "K&#46; Hogan"
                          ]
                        ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nature13298"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24919155"
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        "identificador" => "xack197207"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">The authors wish to acknowledge the invaluable help of K&#46; Kokoriev in developing the figure&#46;</p>"
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