Posted on 10.31.11 at 10:16 am. No Comments.
Great to see this important topic discussed so prominently in the Wall Street Journal. A very, very well done article:
Patricia Landsberg, always a sun worshipper, embraced outdoor living when she moved to Bradenton, Fla., 22 years ago: a waterfront home, boating, golfing and days at the beach.
Now 72, and still working as a real-estate agent, she was preparing for a Botox injection last summer when her dermatologist, Susan Weinkle, noticed a bump under her left eyebrow. A biopsy showed it was a basal cell carcinoma, the most common form of skin cancer—and the second one the doctor had to remove from Ms. Landsberg’s face in five years.
For a growing number of patients 50 and older, those decades of baking in the sun are coming back to haunt them: One in five Americans will develop some kind of skin cancer over the course of a lifetime, according to the Skin Cancer Foundation. Fortunately even the deadliest form, melanoma, can be cured with early detection and proper treatment, but it’s crucial to keep an eye out for any changes in the skin that could signal a malignancy.
Insurers and Screening
Despite the importance of early detection, insurers may not cover screening because the U.S. Preventive Services Task Force, a government advisory body, says there is insufficient evidence to assess the balance of harms and benefits of whole-body skin-cancer screenings by a dermatologist. The group says potential harms of screening include misdiagnosis, overdiagnosis, and the problems that can come from biopsies and overtreatment.
The task force does say clinicians performing physical exams should remain alert for skin lesions with malignant features and biopsy anything suspicious. They should also be alert for those at higher risk of cancer, including fair-skinned men and women age 65 or older, patients with atypical moles and those with more than 50 moles. Family history of skin cancer and a considerable history of sun exposure and sunburn are also risk factors.
Dermatology groups do offer free skin-cancer screenings around the country. The websites of the American Society for Dermatologic Surgery and the American Academy of Dermatology help patients find such screenings, and also offer information on how to examine your own skin and resources such as monthly journals to track changes in a mole.
Basal cell carcinomas like Ms. Landsberg’s develop in about a million people a year, often on sun-exposed areas of the face and head. Though they rarely spread to other parts of the body, they can cause extensive damage to surrounding tissue if not caught and treated early.
Dr. Weinkle, who is president-elect of the American Society for Dermatologic Surgery, treated Ms. Landsberg with an office procedure known as Mohs surgery. After numbing the area, the doctor removes the visible tumor and a thin layer of surrounding tissue. A technician prepares slides, which the surgeon examines under a microscope; if there is evidence of cancer, another layer of tissue is taken. The steps are repeated until only cancer-free tissue remains; the wound may be allowed to heal on its own or sutured, or may require a skin graft.
Though a bit trying—patients must wait as each sample is tested, and often undergo several rounds of tissue removal—it is one of the most effective ways to treat cancers on exposed and delicate areas of the face. According to the National Institutes of Health, there is about a 1% chance of the cancer returning with Mohs, versus a 10% chance with other treatments such as radiation and freezing.
Know Your ABCDE’s
Ronald Moy, a Beverly Hills, Calif., dermatologist and president of the American Academy of Dermatology, says skin cancers and precancerous conditions are often caught when patients come in for cosmetic procedures. He sees many patients with a condition known as actinic keratosis—small, rough, raised areas on the skin that can develop into squamous cell carcinoma, a cancer that in turn can spread to internal organs and be life-threatening. Actinic keratosis can be treated with topical creams and solutions, freezing or a mix of therapies.
Dr. Moy says doctors and patients should be alert to the so-called ABCDE’s of skin-cancer detection: moles or lesions that are asymmetrical in shape, have borders that are uneven, display a variety of colors, are larger in diameter than a pencil eraser, and are evolving or showing new symptoms such as bleeding or itching. “We have to listen when patients tell us something new is bothering them, because something can look benign but may be rapidly changing,” Dr. Moy says.
After a lifetime in the sun and two skin-cancer surgeries, Ms. Landsberg says she is being more careful about exposure, taking extra care with sunscreen, and urging her husband to do the same after he had a basal cell carcinoma on his nose. “I no longer sit and bake in the sun, and I go in at least twice a year to get checked,” she says.
Ms. Landro is an assistant managing editor for The Wall Street Journal and writes the paper’s Informed Patient column. She can be reached at firstname.lastname@example.org.
Posted on 10.26.11 at 11:55 am. No Comments.
A very interesting article that supports you daily cup of coffee was in this week’s LA Times. The study found that drinking coffee was associated with a decreased risk of Basal Cell skin cancer (BCC). BCC is the most common kind of skin cancer and the most common cancer to affect humans. But is the coffee actually causing the decrease or is this just some kind of weird statistical aberration? Maybe people who drink coffee spend more time indoors? Like green tea, coffee is actually a mixture of several different compounds that all could be chemically active in the body. This make finding the exact mechanism or chemical of benefit harder to narrow down. It will be interesting to see if these findings are confirmed in follow-up studies.
By Eryn Brown, Los
Angeles Times / For the Booster Shots blog October 24,
Scientists reported Monday that drinking coffee was
associated with decreased risk of a common and slow-growing form of skin
. It appears that caffeine may play a role, they
The team, based at Brigham and Women’s Hospital and Harvard
Medical School in Boston, presented their study at the American Assn. for Cancer
Research International Conference on Frontiers in Cancer Prevention Research.
Examining data from the Nurses’ Health Study, which followed 72,921
people between 1984 and 2008, and the Health Professionals Follow-Up Study,
which followed 39,976 people between 1986 and 2008, they found 25,480 skin
cancer cases. Basal cell carcinomas represented 22,786 of the cases, squamous
cell carcinomas 1,953 and melanomas 741.
Women who drank more than
three cups of coffee had a 20% reduction in risk for basal cell carcinoma. Men
who drank that much coffee had a 9% reduction in risk of the slow-growing
cancer. People who drank the most coffee had the lowest risk. The team did not
identify reduced risk for squamous cell carcinoma.
Song, a postdoctoral fellow in dermatology,
said that the discovery could help prevent cancers in the future.
dietary factors with even small protective effects may have great public health
impact,” Song said in a statement. “Our study indicates that coffee consumption
may be an important option to help prevent basal cell carcinoma.”
melanomas, which grow rapidly and can be deadly, basal cell carcinomas rarely
spread to other organs. They are the most common form of skin cancer in the
United States, with about a million new cases arising each year. The
Skin Cancer Foundation and the American Cancer Society offer more information about basal
Researchers will have to do more work to identify the
mechanism behind the reduced cancer risk, Song said.
Posted on 10.19.11 at 10:01 am. No Comments.
In previous blogs we commented on the new melanoma drug Yervoy. Despite the great hoopla surrounding its release, we noted that this medication is very expensive (over $100,00 per treatment) and only mildly effective. The National Institute of Health and Clinical Excellence is the agency that decides which drugs will be paid for with public funds in the UK. There is no equivalent agency in the US. Essentially what this agency does it limit medical care, specifically access to medications, for patients in the UK’s health care system. This would not likely be politically palatable in the US and would likely be referred to as some sort of death committee. But in reality this is a rational way of rationing care. This agency looked at the cost of the medicine as well as its poor efficacy, and significant amount of side effects and deemed it not in the public interest to cover this particular medication. Seems like a logical approach to me.