**8. Conclusions**

Skin cancer is the most commonly diagnosed cancer in the U.S. and has become a major and growing public health problem. Despite numerous public health initiatives to promote sun safety, many Americans do not adhere to recommended guidelines to protect themselves from UV exposure. Given the long lag between UV induced skin damage and clinically apparent skin cancer, this reduces the perceived risk of UVR and does not encourage timely behavior modification.

**Acknowledgements**

**Author details**

Adriana T. Lopez<sup>1</sup>

**References**

Center, New York, NY, USA

**64**(21):591-596

2008;**14**(9):1

We thank the funding support by NIH/NIAMS grant K01AR064315, the Columbia University Herbert Irving Comprehensive Cancer Center (P30 CA013696), and the Center for

Molecular Mechanisms and Biomarkers of Skin Photocarcinogenesis

http://dx.doi.org/10.5772/intechopen.70879

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and Larisa Geskin2

1 Columbia University College of Physicians and Surgeons, Columbia University Medical

2 Department of Dermatology, Columbia University Medical Center, New York, NY, USA

[1] Guy GP Jr et al. Vital signs: Melanoma incidence and mortality trends and projections– United States, 1982-2030. Morbidity and Mortality Weekly Report (MMWR). 2015;

[2] Rogers HW et al. Incidence estimate of nonmelanoma skin cancer (Keratinocyte Carcinomas) in the U.S. population, 2012. JAMA Dermatology. 2015;**151**(10):1081-1086 [3] Guy GP Jr et al. Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and

[4] Narayanan DL, Saladi RN, Fox JL. Ultraviolet radiation and skin cancer. International

[5] Sunburn and sun protective behaviors among adults aged 18-29 years–United States, 2000-2010. Morbidity and Mortality Weekly Report (MMWR). 2012;**61**(18):317-322 [6] Buller DB et al. Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: Review from national surveys and case studies of 3 states. Journal of

[7] Matsumura Y, Ananthaswamy HN. Toxic effects of ultraviolet radiation on the skin.

[8] Martin JM et al. Changes in skin tanning attitudes fashion articles and advertisements in the early 20th Century. American Journal of Public Health. 2009;**99**(12):2140-2146 [9] Dadlani C, Orlow SJ. Planning for a brighter future: A review of sun protection and barriers to behavioral change in children and adolescents. Dermatology Online Journal.

2007-2011. American Journal of Preventive Medicine. 2015;**48**(2):183-187

the American Academy of Dermatology. 2011;**65**(5 Suppl 1):S114-S123

Toxicology and Applied Pharmacology. 2004;**195**(3):298-308

Environmental Health in Northern Manhattan (P30 ES009089).

\*, Liang Liu2

\*Address all correspondence to: atl2134@columbia.edu

Journal of Dermatology. 2010;**49**(9):978-986

Our understanding of the pathogenesis of skin cancer at the molecular level has dramatically expanded within the past several years. Although there is still much to be learned about the underlying mechanisms of skin cancer pathobiology, advances in genetic sequencing have provided great insight into the ways in which effective tests may be developed for patient risk stratification of NMSC. This has since paved the way for pursuit of novel applications of this information, which have the potential to profoundly improve patient care.

Clinical biomarker discovery has led to revolutionary changes in medical screening, diagnosis, and target based therapies for a variety of cancers. In the era of precision medicine, individualized patient care is becoming increasingly important in all fields of medicine. While UVR has long been known to be a key risk factor for skin cancer development, increasing evidence has demonstrated that its role in carcinogenesis is likely multifactorial and involves multiple biologic pathways. Despite this, identification of cellular dysregulation in key regulatory pathways has provided insight into potential biomarkers of disease.

Various types of biomarkers including DNA, RNA, and protein have been suggested for use in diagnostic and prognostic testing for various malignancies. Identification of individual biomarkers that produce consistent and reliable information on UV damage has posed a significant clinical challenge. We believe that a successful clinical test consisting of a panel of UV signature genes will provide the most sensitive and specific means for patient risk stratification of UV skin damage. Within NMSC research, RNA-based UV biomarkers currently exhibit the most promise for future clinical application given the multiple, reliable, and costeffective modalities for RNA detection.

The current lack of skin cancer screening guidelines in the United States has resulted in a non-standardized approach to skin cancer screening and physician risk assessment. Thus, a UV biomarker-based screening test could provide an objective and evidence based method to determine which patients should receive regular skin cancer screening facilitate the identification of high risk individuals for dermatology referral and regular skin cancer screening. By encouraging early risk assessment, we believe that a biomarker-based diagnostic test will greatly improve skin cancer prevention and reduce skin cancer incidence.

Furthermore, translation of UV biomarker expression patterns into a risk score would hopefully offer quantitative and convincing evidence to alert susceptible individuals and encourage UV protective behaviors. Finally, development of a reliable UV biomarker panel could be used for other purposes such as testing the UV-protective effects of sunscreens. We believe this area of research deserves continued attention as the development of UV biomarker based tests has the potential to completely transform the preventative paradigm pertaining to skin cancer.
