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BACKGROUND: Worldwide inci den ce of mela no ma has increa sed in recent years fas ter than any other cancer. Although it repre sents only 4% of skin can cers it is never the less res pon si ble for 60% of skin can cer deaths. This makes mela no ma a public health pro blem. OBJECTIVES: The aim of this study was the deve lop ment of a con ti nuous pro gram for mela no ma pre ven tion and early detec tion. METHODS: A city of around 130,000 inha bi tants in the state of São Paulo, Brazil, was cho sen for the deve lop ment of a pilot pro ject cove ring pri mary pre ven tion and early diag no sis of mela no ma. A nur sing team wor ked for appro xi ma tely 30 days in each of the 13 health cen ters in the city of Jaú (SP), pro vi ding gui dan ce on self-exa mina tion of the skin, pho to pro tec tion and recog ni tion of early signs of mela no ma. Patients with sus pi cious lesions were imme dia tely sent to the refe ren ce hos pi tal for medi cal and der mos co pic scree ning. Excisional biop sies were per for med on sus pec ted mela no mas. RESULTS: 4 four cases of early stage mela no ma and 3 dysplas tic nevi were diag no sed. Of the peo ple inter vie wed, 74% wor ked either part-time or full-time expo sed to sun and over 60% clai med to never use suns creen. CONCLUSION: This is a new and effec ti ve model for mela no ma pre ven tion and early diag no sis. In short, the melano ma pre ven tion pro gram is able to quickly iden tify sus pi cious lesions, lea ding to early diag no sis and bet ter chan ces of sur vi val. Keywords: Early diag no sis; Melanoma; Disease pre ven tion Resumo: FUNDAMENTO: A inci dên cia do mela no ma aumen tou nos últi mos anos mais rapi da men te do que qual quer outro cân cer. Embora repre sen te ape nas 4% dos cân ce res de pele, é o res pon sá vel por 60% das mor tes por esta neo pla sia. Isto torna o mela no ma um pro ble ma de saúde públi ca. OBJETIVOS: O pre sen te estu do pro pôs o desen vol vi men to de um Programa Contínuo de Prevenção do Melanoma, por meio da rea li za ção da pre ven ção pri má ria e do diag nós ti co pre co ce desta neo pla sia. MÉTODOS: Foi toma da como pilo to uma cida de de apro xi ma da men te 130.000 habi tan tes. Uma equi pe de enfer magem este ve pre sen te por cerca de 30 dias em cada um dos 13 pos tos de saúde da cida de de Jaú (SP), rea li zan do orien ta ções quan to ao autoe xa me da pele, foto pro te ção e sinais pre co ces do mela no ma. O pacien te com lesão suspei ta era enca mi nha do ime dia ta men te ao hos pi tal de refe rên cia para der ma tos co pia e tria gem médi ca, sendo excisa da quan do sus pei ta. RESULTADOS: Foram diag nos ti ca dos 4 casos de mela no ma em fase ini cial e 3 nevos dis plá si cos. Dos entre vis ta dos, 74% tra ba lham expos tos ao sol, varian do de meio perío do ao com ple to, e mais de 60% nunca fize ram uso de fil tro solar. CONCLUSÃO: Este mode lo de pro gra ma de pre ven ção é iné di to, exclu si vo e demons trou ser efi caz na pre ven ção e diag nós ti co pre co ce do mela no ma em uma cida de de 130.000 h...

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The photodynamic therapy (PDT) is an alternative technique that can be used for treating superficial basal cell carcinoma (sBCC), Bowen's disease and actinic keratosis with highefficiency. The objective of this study is to present a method where fluorescence imaging together with for PDT as a monitoring guidance in real time. Confirming that the lesion is well prepared and the photosensitizer shows a homogenous distribution, the outcome after few PDT sessions will be more predictable and the recurrence is minimized. Our proposition in this study is use the widefield fluorescence imaging to evaluate the PDT protocol in situ and in real time for each lesion. This evaluation procedure is performed in two steps: first with the monitoring of the production of protoporphyrin IX (PpIX) induced by methyl aminolevulinate (MAL), a derivative of 5-aminolevulinic acid (ALA) and second with the detection of PpIX photobleaching after illumination. The fluorescence images provide information correlated with distinct clinical features and with the treatment outcome. Eight BCC lesions are presented and discussed in this study. Different fluorescence patterns of PpIX production and photobleaching could be correlated with the treatment response. The presented results show the potential of using widefield fluorescence imaging as a guidance tool to customized PDT. This procedure is being incorporated to the main PDT skin cancer protocol applied in Brazil with an excellent outcome.

Treatment using light-activated photosensitizers (photodynamic therapy, PDT) has shown limited efficacy in pigmented melanoma, mainly due to the poor penetration of light in this tissue. Here, an optical clearing agent (OCA) was applied topically to a cutaneous melanoma model in mice shortly before PDT to increase the effective treatment depth by reducing the light scattering. This was used together with cellular and vascular-PDT, or a combination of both. The effect on tumor growth was measured by longitudinal ultrasound/photoacoustic imaging in vivo and by immunohistology after sacrifice. In a separate dorsal window chamber tumor model, angiographic optical coherence tomography (OCT) generated 3D tissue microvascular images, enabling direct in vivo assessment of treatment response. The optical clearing had minimal therapeutic effect on the in control, non-pigmented cutaneous melanomas but a statistically significant effect (p < 0.05) in pigmented lesions for both single- and dual-photosensitizer treatment regimes. The latter enabled full-depth eradication of tumor tissue, demonstrated by the absence of S100 and Ki67 immunostaining. These studies are the first to demonstrate complete melanoma response to PDT in an immunocompromised model in vivo, with quantitative assessment of tumor volume and thickness, confirmed by (immuno) histological analyses, and with non-pigmented melanomas used as controls to clarify the critical role of melanin in the PDT response. The results indicate the potential of OCA-enhanced PDT for the treatment of pigmented lesions, including melanoma.

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