Oliver Brittany, Durrani Serena, Cohen Joel L, Friedman Adam J
J Drugs Dermatol. 2017 May 1;16(5):449-452.
Introduction: Nonmelanoma skin cancer (NMSC) is the most common malignancy in the US Primary prevention of NMSC with physical photoprotective measures are often not sufficient to impact skin cancer incidence in high-risk individuals. Chemoprevention is the use of agents to prevent, suppress, and reverse carcinogenic progression. Many agents have been investigated, but preclinical and clinical studies are often inconsistent.
Methods: A cross-sectional study was designed to assess current practices, perceptions, and general knowledge of U.S. dermatologists pertaining to chemopreventive strategies. This voluntary online survey was distributed to practicing dermatologists via dermatology society electronic mailing lists. Software from SurveyGizmo.com was used for survey implementation and anonymous data collection. Stata 12.0 statistical analysis software (StataCorp, LP) was used to perform nonparametric Spearman correlation tests.
Results: Approximately half of the 156 responding dermatologists reported being in practice 16 years or more (47.3%) and working in urban communities (48.7%). 59.3% reported "frequently" using topical therapies, while only 13.7% reported frequent use of systemic chemopreventive therapies. Dermatologists practicing in urban settings were more likely to indicate they believe knowledge has increased substantially (P=0.047) as compared to colleagues in other communities. Respondents also reported varying degrees of confidence in selecting appropriate chemopreventive regimens: most feel comfortable determining which agents to use in patients, but 29.1% answered "neutral" or "disagree" when asked if they felt comfortable. More experienced dermatologists were more likely to recommend diet modifications such as increased dietary vitamin D (P=0.014), low fat diet (P=0.022), and tea polyphenols (P=0.04) as methods of chemoprevention.
Discussion: Efforts to identify effective, minimally-toxic chemopreventive agents have long been underway, but conflicting reports in the literature make formulation of validated guidelines challenging. Our study suggests differing perceptions, comfort levels, and practice strategies among U.S. dermatologists. This serves to identify areas of research requiring additional contributions from clinical investigators and reveals a need to broaden understanding of available evidence-based techniques.
J Drugs Dermatol. 2017;16(5):449-452.
.非黑色素瘤皮肤癌（NMSC）是美国最常见的恶性肿瘤。采用物理防晒措施对NMSC进行一级预防，往往不足以影响高危个体的皮肤癌发病率。化学预防是指使用药物来预防、抑制和逆转致癌进程。许多药物已被研究，但临床前和临床研究结果常常不一致。
设计了一项横断面研究，以评估美国皮肤科医生在化学预防策略方面的当前做法、认知和一般知识。这项自愿在线调查通过皮肤病学协会的电子邮件列表分发给执业皮肤科医生。使用SurveyGizmo.com的软件进行调查实施和匿名数据收集。使用Stata 12.0统计分析软件（StataCorp，LP）进行非参数Spearman相关性检验。
156名回复的皮肤科医生中，约一半报告其执业年限为16年或更长（47.3%），且在城市社区工作（48.7%）。59.3%报告“经常”使用局部治疗，而只有13.7%报告经常使用全身化学预防治疗。与其他社区的同事相比，在城市环境中执业的皮肤科医生更有可能表示他们认为知识有了大幅增加（P = 0.047）。受访者还报告了在选择合适的化学预防方案方面有不同程度的信心：大多数人对确定在患者中使用哪些药物感到放心，但当被问及是否放心时，29.1%的人回答“中立”或“不同意”。经验更丰富的皮肤科医生更有可能推荐饮食调整，如增加膳食维生素D（P = 0.014）、低脂饮食（P = 0.022）和茶多酚（P = 0.04）作为化学预防方法。
长期以来一直在努力寻找有效、低毒的化学预防药物，但文献中的相互矛盾的报告使得制定经过验证的指南具有挑战性。我们的研究表明美国皮肤科医生之间存在不同的认知、舒适度和实践策略。这有助于确定需要临床研究人员做出更多贡献的研究领域，并揭示需要更广泛地了解现有的循证技术。
《皮肤药物学杂志》。2017年；16(5):449 - 452。
