Archive for 2010
As time and financial pressures on physicians continues to increase, the length of doctor’s appointments seem to get shorter and shorter. So, it’s important to go into every appointment prepared with questions that will help you get the most out of your visit.
Following are questions patients should consider asking their primary care physician or dermatologist to help them stay vigilant against melanoma:
- How often should I get checked? You should understand your risk profile and act on it.
- What should I look for during a self skin check? Go beyond the ABCDE’s; get a “tutorial” on your own moles from your physician.
- What can I do to reduce my risk? We all know that ultraviolet exposure increases risk and it’s important to make sure you’re aware of commonly overlooked sources of UV exposure.
- Who will analyze my skin biopsy? Dermatopathologists are experts in diagnosing skin diseases, so know whether your biopsy is being evaluated by a specialist or a generalist.
- Who are the healthcare professionals who will treat me if I’m faced with a melanoma diagnosis? If you are faced with a diagnosis, it’s important to know your options and understand which professionals bring the experience you need.
Please click here for more information and discussion on these important quesitons.
Celecoxib reduced the likelihood of pre-cancerous abnormal cells generating non-melanoma skin tumours.
The drug, marketed in the UK under the name Celebrex, is a non-steroidal anti-inflammatory drug (NSAID). It targets the enzyme cyclo-oxygenase 2 (Cox-2) which is believed to be involved in the development of non-melanoma skin cancers triggered by too much sun exposure.
Four years ago the drug was at the centre of controversy after research suggested it might increase the risk of heart attacks and strokes.
Celecoxib belongs to the same drug family as Vioxx, which was withdrawn from the market following similar concerns.
US scientists conducting the new study looked at the effect of celecoxib on 240 people who already had actinic keratosis – pre-cancerous skin damage.
The drug did not alter the number of lesions appearing after two months of treatment, but by the end of the trial participants taking celecoxib had significantly fewer non-melanoma skin cancers than those given a “dummy” placebo pill.
Dr Craig Elmets, from the University of Alabama, and colleagues wrote in the Journal of the National Cancer Institute which published the research online: “The findings of this study, which showed that the celecoxib-treated individuals developed fewer non-melanoma skin cancers than placebo-treated individuals, suggest that cyclo-oxygenase inhibitors may provide an additional benefit to sunscreens in the prevention of non-melanoma skin cancers.”
Non-melanoma skin cancers include cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs). They are much less dangerous than melanoma cancers and can often be cured.
Previous research has shown that celecoxib can hold back the development of bowel cancer.
“I believe chemosurgery with zinc chloride paste, followed by wide excision, is a better way to remove a melanoma than fresh tissue surgery.”
There was a very interesting review published recently about the use of Zinc Chloride paste and treating melanoma. This is a technique that is not widely known – but amongst the people who do know it – widely admired. The idea here is that applying Zinc Chloride paste to a melanoma BEFORE it is excised may stimulate an immune response to help the body fight the melanoma. Almost in a similar way that a melanoma vaccine would work.
Pros: May improve survival, Does not interfere with the standard of care (ie: this is a complement to the standard – not a substitution for the standard), Inexpensive, Anyone with a deep melanoma would be a candidate, May help treat distant metastatic lesions
Cons: Not FDA approved, May be difficult to find a dermatologist who has/knows of the technique, Some patients can develop flue like symptoms while the immune response occurs (which may be related to a better response to treatment)
It is our hope that researchers will pick up this pearl and conduct a formalized study, as formal research on this technique is sorely lacking – likely because there is no pharmaceutical incentive to sponsor the research
The full article can be found here.
Regular use of sunscreen during a clinical trial of basal cell and squamous cell carcinomas was found to reduce the incidence of a different skin malignancy – new primary melanomas – up to 10 years later, according to a study published online Dec. 6 in the Journal of Clinical Oncology.
The number of invasive melanomas in particular decreased by 73%, but this was an exploratory finding “and should be interpreted cautiously,” said Dr. Adéle C. Green and her associates at the Queensland Institute of Medical Research, Royal Brisbane (Australia) Hospital.
For the complete article, click here.
Skiers and other outdoor enthusiasts need to be aware that factors such as weather conditions and time of day can cause considerable variation in the levels of ultraviolet (UV) radiation during the winter, researchers say.
They analyzed data collected between 2001 and 2003 at 32 high-altitude ski resorts in western North America. They also interviewed adult guests at the resorts and looked at their clothing and equipment in order to assess their level of sun protection.
Adolescents who use sunbeds have an increased risk of early-onset melanoma according to findings from the Australian Melanoma Family Study. The study showed that the risk of developing melanoma was 1.41 for those who ever tanned and 2.01 for those who tanned 10 times or more.
The best chance we have in reducing the risk of Melanoma is educating our youth.
This is a story of the little “dot” that appeared on my arm and proceeded to change my entire life. The dot introduced me to words I never imagined I would hear: “Mr. McCullough, you have cancer. It is a malignant melanoma, we have gone ahead with scheduling you for emergency surgery.”
Growing up, I had a mother who instilled in me and my brothers the importance of sun protection. For me, it sunk in. I was not someone who had to get a tan. Nor did I see it as something that was attractive in others. I was an athlete, though. I played just about everything. To give you an example of my sun protection choices, I played beach volleyball in a shirt. And not just any shirt, I wore a long sleeve t-shirt. Of course, this had more to do with the fact that I loved diving, and I discovered the best way to limit the sand abrasion on my elbows was to wear a shirt with sleeves.
ABCD rule illustration. On the left side from top to bottom: melanomas showing (A) Asymmetry, (B) a border that is uneven, ragged, or notched, (C) coloring of different shades of brown, black, or tan and (D) diameter that had changed in size. The normal moles on the right side do not have abnormal characteristics (no asymmetry, even border, even color, no change in diametry).
To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see “ABCD” mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy.
A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”:
- Asymmetrical skin lesion.
- Border of the lesion is irregular.
- Color: melanomas usually have multiple colors.
- Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
- Enlarging: Enlarging or evolving
A weakness in this system is the D. Many melanomas present themselves as lesions smaller than 6 mm in diameter; and likely all melanomas were malignant on day 1 of growth, which is merely a dot. An astute physician will examine all abnormal moles, including ones less than 6 mm in diameter. Seborrheic keratosis may meet some or all of the ABCD criteria, and can lead to false alarms among laypeople. An experienced doctor can distinguish seborrheic keratosis from melanoma upon examination, or with dermatoscopy.
Some will advocate the system “ABCDE”, with E for evolution. Certainly moles which change and evolve will be a concern. Alternately, some will refer to E as elevation. Elevation can help identify a melanoma, but lack of elevation does not mean that the lesion is not a melanoma. Most melanomas are detected in the very early stage, or in-situ stage, before they become elevated. By the time elevation is visible, they may have progressed to the more dangerous invasive stage.
A recent and novel method of melanoma detection is the “Ugly Duckling Sign” It is simple, easy to teach, and highly effective in detecting melanoma. Simply, correlation of common characteristics of a person’s skin lesion is made. Lesions which greatly deviate from the common characteristics are labeled as an “Ugly Duckling”, and further professional exam is required. The “Little Red Riding Hood” sign suggests that individuals with fair skin and light colored hair might have difficult-to-diagnose melanomas. Extra care and caution should be rendered when examining such individuals as they might have multiple melanomas and severely dysplastic nevi. A dermatoscope must be used to detect “ugly ducklings”, as many melanomas in these individuals resemble non-melanomas or are considered to be “wolves in sheep clothing”. These fair skinned individuals often have lightly pigmented or amelanotic melanomas which will not present easy-to-observe color changes and variation in colors. The borders of these amelanotic melanomas are often indistinct, making visual identification without a dermatoscope (dermatoscopy) very difficult.
People with a personal or family history of skin cancer or of dysplastic nevus syndrome (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma.