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Carotenoids are thought to play a significant part in the skin's anti-oxidant defense system, and may help prevent malignancy. Inability to measure skin carotenoid content readily has, however, made it difficult to establish the relationship between carotenoid concentration and the occurrence of cutaneous malignancy. We have measured in vivo carotenoid concentration using a noninvasive optical method, Raman spectroscopy. To validate our instrumentation, abdominoplasty skin was evaluated by both Raman spectroscopy and high-performance liquid chromatography determination for carotenoid content. Evaluation of the Raman signal in specific carotenoid solutions was also performed. Precision of Raman measurements within skin sites, within subjects, and between subjects was measured. Sensitivity of the method was evaluated as a function of anatomical region and the distribution of carotenoids within the stratum corneum. Lastly, we evaluated the Raman signal in actinic keratosis and basal cell carcinoma lesions and perilesional skin and compared this with region-matched sites in healthy subjects. Our results indicate that the Raman scattering method reflects the presence of carotenoids in human skin and is highly reproducible. Evaluation of five anatomical regions demonstrated significant differences in carotenoid concentration by body region with the highest carotenoid concentration noted in the palm. Comparison of carotenoid concentrations in basal cell carcinomas, actinic keratosis, and their perilesional skin demonstrate a significantly lower carotenoid concentration than in region-matched skin of healthy subjects. These results represent the first evidence that carotenoid concentration in the skin correlate with the presence or absence of skin cancer and precancerous lesions.

Purpose-Dietary carotenoids lutein and zeaxanthin may play a protective role against visual loss from age-related macular degeneration (AMD) through antioxidant and light screening mechanisms. We used a novel noninvasive objective method to quantify lutein and zeaxanthin in the human macula using resonance Raman spectroscopy and compared macular pigment levels in AMD and normal subjects. Design-Observational study of an ophthalmology clinic-based population.Participants and Controls-Ninety-three AMD eyes from 63 patients and 220 normal eyes from 138 subjects.Methods-Macular carotenoid levels were quantified by illuminating the macula with a lowpower argon laser spot and measuring Raman backscattered light using a spectrograph. This technique is sensitive, specific, and repeatable even in subjects with significant macular pathologic features.Main Outcome Measure-Raman signal intensity at 1525 cm −1 generated by the carboncarbon double-bond vibrations of lutein and zeaxanthin.Results-Carotenoid Raman signal intensity declined with age in normal eyes (P < 0.001). Average levels of lutein and zeaxanthin were 32% lower in AMD eyes versus normal elderly control eyes as long as the subjects were not consuming high-dose lutein supplements (P = 0.001). Patients who had begun to consume supplements containing high doses of lutein (≥4 mg/day) regularly after their initial diagnosis of AMD had average macular pigment levels that were in the normal range (P = 0.829) and that were significantly higher than in AMD patients not consuming these supplements (P = 0.038).Conclusions-These findings are consistent with the hypothesis that low levels of lutein and zeaxanthin in the human macula may represent a pathogenic risk factor for the development of Correspondence and reprint requests to Paul S. Bernstein, MD, PhD, Moran Eye Center, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132. paul.bernstein@hsc.utah.edu. Three authors (PSB, RWM, and WG) and the University of Utah hold patent rights to the ocular Raman technology described in this article, and these authors and the university own significant equity interests in Spectrotek, LC, a company that has licensed the technology.Presented in part as a poster at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, November 2001. A major epidemiologic study found that high dietary intakes and blood levels of these xanthophyll carotenoids are correlated with a significantly lower risk of AMD, 12,13 but another study did not reach the same conclusion. 14 These inconsistent findings derive in part from the fact that blood levels and dietary intakes of lutein and zeaxanthin are relatively poor markers of the actual amounts present in the macula. 15 Clearly, it is of utmost importance to know the levels of lutein and zeaxanthin at their relevant site of action, the human macula. Recently, an autopsy study has reported that eyes from donors with a history of AMD had lower levels of macular carotenoids than eyes wi...