EXCEED THE SPACE PROVIDED. Skin cancer, the most common cancer in the U.S., is more prevalent than all other malignancies combined. Basal cell carcinoma (BCC), one of the most common forms of human cancer, shows evidence for spontaneous regression in approximately 44% of the tumors. Importantly, both spontaneous regression of tumors and appearance of new tumors appear to be related to the immune response to the tumor. This study addresses the interplay among psychological, neuroendocrine, and immune function in BCC patients, and how this interplay may be related to immune/molecular markers associated with histopathological characteristics of regressing vs. non-regressing tumors. We will recruit 320 patients who have recently had a BCC removed (the 'index' tumor), and 64 control subjects. Two pathologists will evaluate the tumors and classify them as regressing or non-regressing; they will also determine the tumor subtype. We will evaluate cross-sectional relationships between hormones and immune function and the regressing/non-regressing status of the BCC, as well as the influence of age, gender, severe life events, and depressive symptoms on these relationships. We also propose to follow these patients with subsequent annual evaluations to examine longitudinal relationships.
Specific aims : 1) To determine if depressive symptoms and severe life events are related to levels of immunoreactivity to the index BCC (i.e., non-regressing versus regressing histopathological characteristics), greater stress hormone secretion, poorer immune function, and higher rates of new BCCs at follow-ups; to determine if these relationships are more pronounced among older adults. 2) To determine if aspects of immune function (T-cell immunity and apoptosis) are down-regulated in patients with non-regressing tumors, and if patients who show greater immunoreactivity/apoptosis in their index BCC tumor are less likely to have new BCC tumors at follow-up. 3) To assess whether BCC patients differ on peripheral blood immune measures from sociodemographically-comparable controls. 4) To determine if the activation of the HPA and/or SAM axes (measured by levels of several stress hormones) mediates the degree of immunoreactivity observed in the tumor tissue, and whether these interactions are associated with non-regression/regression status of the tumor. PERFORMANCE SITE ========================================Section End===========================================
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