Dermoscopy after topical treatment of BCC

I thought this is a very interesting study.




Br J Dermatol. 2013 Nov 27. doi: 10.1111/bjd.12749. [Epub ahead of print]

Applicability of dermoscopy for evaluation of patients’ response to non-ablative therapies for the treatment of superficial basal cell carcinoma.


State Clinic of Dermatology, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece.



Applicability of dermoscopy in evaluation of outcome and monitoring of superficial basal cell carcinoma (sBCC) after non-ablative therapies has not been sufficiently assessed.


Certain dermoscopic criteria, namely pigmented structures, ulceration and arborizing vessels have been suggested to predict presence of residual disease (residual disease-associated dermoscopic criteria-RDADC). We aimed to assess this hypothesis.


Lesions exhibiting RDADC 3 months after treatment were biopsied and in case of histopathologic confirmation were excised. Lesions characterized by white/red structureless areas, superficial fine telangiectasias, or lacking any dermoscopic criterion, were monitored for 12 months.


At the 3-month evaluation, one or more of the RDADC were detected in 25/98 (25.5%) sBCCs, in which histology confirmed tumor persistence. In 45(61.6%) of the 73 remaining lesions, dermoscopy showed red/white structureless areas and/or superficial fine telangiectasias. Twenty-eight lacked any dermoscopic criterion of sBCC. The two latter groups entered follow-up. In total, disease recurred in 13 (17.8%) of the 73 lesions.


RDADC accurately predict residual disease. Absence of dermoscopic criteria of sBCC safely predicts complete histopathologic clearance. Detection of red/white structureless areas and/or superficial fine telangiectasias warrants close monitoring to recognize early recurrence.

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Skin cancer is 70% more deadly for men: Women have better chance of surviving melanoma



Men are 70 per cent more likely to die from malignant melanoma – the most serious type of skin cancer – than women, figures suggest.

This is despite similar numbers of men and women being diagnosed with the disease every year in the UK.

Cancer Research UK data for 2011 – the most recent available – shows 3.4 men per 100,000 die from malignant melanoma compared with two per 100,000 women.

This means that of the 6,200 men who develop melanoma each year, 1,300 die from the disease, compared with 900 of the 6,600 women.

The likelihood of getting the disease is similar between the sexes, with 17.2 men per 100,000 diagnosed compared with 17.3 women.

Since the early 1970s, death rates in men have increased by 185 per cent compared to 55 per cent in women, the charity said.

And it predicts death rates will continue to rise in men while remaining stable in women.

Professor Julia Newton-Bishop, Cancer Research UK dermatologist based at the University of Leeds, said: ‘Research has suggested the difference between the sexes could be in part because men are more likely to be diagnosed when melanoma is at a more advanced stage.

‘But there also seem to be strong biological reasons behind the differences and we’re working on research to better understand why men and women’s bodies deal with their melanomas in different ways.

‘We also know that men and women tend to develop melanoma in different places – more often on the back and chest for men and on the arms and legs for women.

One of the reasons for the difference (between men and women) may be attitudes towards seeing a doctor.

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This study is very interesting. I had no idea that this was so high. regards Ian

Late Recurrence in Melanoma: Clinical Implications of Lost Dormancy

Journal of the American College of Surgeons Volume 217, Issue 1 , Pages 27-34, July 2013


For patients with melanoma, if there has been no recurrence of disease 10 years after initial treatment, additional disease is believed to be very unlikely. However, such late recurrences are known to occur. The frequency of this phenomenon and its clinical significance are not well characterized due to the difficulty in obtaining relevant data. We examined a large, mature, institutional database to evaluate late recurrence.

Study Design

The late recurrence cohort was defined as having a disease-free interval of 10 or more years after potentially curative treatment and was compared with an early recurrence cohort recurring within 3 years. Actuarial late recurrence frequency and factors associated with late recurrence were examined. Post-recurrence overall and melanoma-specific survival and prognostic variables were analyzed.


Among all patients, 408 exhibited late recurrence (mean disease-free interval 15.7 years). For patients who received primary treatment at our institution with 10 or more years follow-up, 327 of 4,731 (6.9%) showed late recurrence. On an actuarial basis, late recurrence rates were 6.8% and 11.3% at 15 and 20 years, respectively, for those with no recurrence at 10 years. Late recurrence was associated with both tumor (thin, non-ulcerated, non-head/neck, node negative) and patient (younger age, less male predominant) characteristics. Multivariate analysis confirmed younger age, thinner and node negative tumors in the late recurrence group. Late recurrences were more likely to be distant, but were associated with better post-recurrence survival on univariate and multivariate analyses.


Late melanoma recurrence is not rare. It occurs more frequently in certain clinical groups and is associated with improved post-recurrence survival.

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Caffeine intake and risk of basal cell and squamous cell carcinomas of the skin

Hi all


It appears that drinking significant amounts of coffee reduces your risk of skin cancer




Caffeine intake and risk of basal cell and squamous cell carcinomas of the skin in an 11-year prospective study



Caffeine may repair skin damage induced by excessive exposure to ultraviolet light. The purpose of this study was to investigate the association between caffeine intake and incidence of basal cell (BCC) and squamous cell carcinoma (SCC). We also assessed the associations between coffee consumption and incidence of these skin cancers.


Caffeine intake and consumption of coffee were estimated from food frequency questionnaires assessed in 1992, 1994, and 1996 among 1,325 randomly selected adult residents of a subtropical Australian community. All histologically confirmed tumours of BCC and SCC occurring between 1997 and 2007 were recorded. Associations with BCC and SCC were assessed using Poisson and negative binomial regression models and were adjusted for confounders including skin type and indicators of past sun exposure.


There was no association between total caffeine intake and incidence of BCC or SCC. Participants with prior skin cancers, however, had a 25 % lower risk of BCC if they were in the highest tertile of total caffeine intake (equivalent to daily consumption of four cups of regular coffee) compared with the lowest tertile (multivariable RR 0.75; 95 % CI 0.57–0.97, P trend = 0.025). There was no dose–response relationship with SCC. Consumption of neither caffeinated nor decaffeinated coffee was associated with BCC or SCC.


Among people with prior skin cancers, a relatively high caffeine intake may help prevent subsequent BCC development. However, caffeine intake appears not to influence the risk of SCC.


Nested melanoma

Hi there

Here is a  new article on this newly identified entity:

Dermoscopy and Confocal Microscopy of Nested Melanoma of the Elderly: Recognizing a Newly Defined Entity

Importance  Nested melanoma of the elderly is a newly identified histopathologic variant of superficial spreading melanoma, characterized by intraepidermal large nests. However, the clinical, dermoscopic, and confocal aspects have been depicted only partially.

Observations  In our cases series, nested melanoma was a flat, irregularly shaped lesion with variably pigmented and irregularly distributed globules on dermoscopic examination. Confocal microscopy revealed the presence of a “clod” pattern made of large compact nests with variable atypia. These findings correlated well with histopathologic features.

Conclusions and Relevance  Nested melanoma of the elderly should be included in the differential diagnosis when a flat pigmented lesion, showing dermoscopically an irregular globular pattern, is seen in a patient older than 60 years.

and the editorial comment:



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Patient and doctor reporting of complications after skin surgery

Hi all

I found this really interesting. I certainly see that certain sociodemographic groups complain more after simple skin procedures than others.  I think it is all perception.




(Reuters Health) – More than one quarter of people being treated for non-melanoma skin cancer in their doctor’s office reported some type of complication after surgery, in a new study.

About half of those complications were medical problems related to the cancer-removing procedure, including pain, infections and slow wound healing.

But just 3 percent of doctors noted a complication in the same patients’ medical records, researchers reported this week in JAMA Internal Medicine.

“It’s important, in order to improve care and improve quality of care, to be aware of what our weaknesses are as physicians,” said Dr. Eleni Linos, who led the new study at the University of California, San Francisco.

“If a quarter of Toyota customers were unhappy after service, they would take that very seriously,” she said – the same as if a quarter of Appleproduct buyers didn’t like their purchases.

The researchers followed 866 people – mostly older men – being treated for non-melanoma skin cancer, which includes basal and squamous cell cancers.

About 2.2 million people are diagnosed with those cancers every year in the U.S., but only 2,000 or so die, according to the American Cancer Society.

One recent report, also from Linos and her colleagues, found most people with non-melanoma skin cancer undergo surgery to treat it – even though for some elderly or ill patients, benefits are unlikely (see Reuters Health story of April 29, 2013 here:

This time, the researchers sent questionnaires to patients who had undergone some type of in-office skin cancer procedure for up to five years after their surgery.

Thirteen percent of them reported a non-medical problem, such as issues with their scar or appearance or difficulty getting to appointments. Another 14 percent said they had a medical complication – most commonly pain, numbness or itching, problems with wound healing or infections.

One in ten people reported a moderate or severe complication on a post-surgery questionnaire.

In contrast, Linos and her colleagues found doctors noted a complication in the medical charts of just 22 of those patients, or 3 percent.

She said the proportion of patients who reported a complication was “sky high” compared to what the researchers were expecting.


Patients might have a broader view of what counts as a complication, she said, such as disliking bandages or scars. Or, doctors may simply not ask patients about their post-surgery problems often enough – and may miss chances to address treatable issues.

Complications can be subjective for patients, and even scarring can be “life-altering” for certain people, according to Anthony Simon Bates, who has studied how patients are asked about complications of skin cancer surgery at the UK’s University of Bristol.

“There’s a real need to manage patient expectations and for doctors to provide adequate pre-operative advice and information to patients,” Bates, a medical student who wasn’t involved in the new research, told Reuters Health.

According to Linos, the same patterns have been suggested for hospital care, as well as medication side effects: what patients experience can be very different from what doctors expect.

“The bottom line is, it’s worth asking patients what they’re experiencing directly,” she said. “We’re all on the same team, but often we may not be as aware as the patient is about their own experience.”

SOURCE: JAMA Internal Medicine, online May 20, 2013.


Talk at GPCE about utility of shave biopsies

Hi all

This may be interesting to you

I also video’d it and will make it available.