Archive for July, 2011

Skin cancer vaccine hope

From the Sun-Hearld

CANCER expert Prof Ian Frazer is on the verge of a major breakthrough in skin cancer – he hopes to develop a vaccine within a year.

The former Australian of the Year and creator of the world’s first cervical cancer vaccine, Gardasil, has developed a world-first strategy to combat the insidious disease that affects two out of three Australians.

“In my lifetime we should be able to remove the threat of skin cancer from the next generation,” the 57-year-old immunology professor said.

“The smoking gun evidence is there is a virus or viruses that cause it.”

Prof Frazer believes people can “catch” cancer from a virus.

He proved his theory by identifying the human papilloma virus (HPV) as the cause of cervical cancer and then developing a vaccine against the virus to rid the female population of the cancer.

Now he is using a similar tactic to try to combat skin cancer, including malignant melanomas.

“This group of cancers caused by virus infection present a great opportunity because the idea of vaccinating to prevent a cancer is enormously appealing,” he said.

Prof Frazer said the problem was two-fold.

“Genetics and variations in people’s immune systems may expose some people to greater risk of skin cancer after sun exposure,” he said.

“If you take away the body’s defence systems, skin cancer becomes more common.”

His theory is that some viruses – particularly the wart virus or HPV – are embedded in the layers of the skin, which then pose a skin cancer risk for people with damaged immune systems.

“The technology now exists for me to test my theory,” Prof Frazer said.

“It is very powerful but also very expensive.

“Using this tool, we will go hunting for the fingerprints of the virus or viruses present.”

Prof Frazer’s team will input all the sequenced genetic information on skin cancer – which will take six months – and then get an answer.

“We will know if a virus causes skin cancer and what virus it is,” he said.



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Should one offer an unsolicited dermatologic opinion? Ethics for the locker-room dermatologist

Interesting article in JAAD, July 2011

Appreciate any comments please


While changing in the locker room after a workout, Dr Jones, a dermatologist, notices a lesion on the upper back of someone two lockers over that immediately catches her eye. From a distance, it appears to be variegated in color and measures 1 to 2 cm in size, and the lesion arouses suspicion of malignant melanoma.
Dr Jones should:
A. Say nothing, as she has not been asked for her opinion.
B. Walk over to the person two lockers over and introduce herself as a dermatologist and tell her that something on her back caught her eye, and if it is all right with her, she would be willing to take a closer look.
C. Approach the person two lockers over and introduce herself as a dermatologist and tell her that she is worried about the lesion based on its appearance, give her her business card, and suggest that the person contact her as soon as possible for follow-up in the office.
D. Introduce herself as a dermatologist and suggest that something on her back caught her eye and she recommends that that the person contact her physician to have it evaluated more closely.


Skin contact allergies reduce risk of skin cancer!

Does nickel make you itch? Skin allergies may reduce risk of cancer by ‘priming immune system

Skin allergies can cause immense grief to sufferers but now scientists have some good news – the itchy condition could also help ward off cancer. Danish researchers found that those who reacted to common irritants such as perfume or nickel were less likely to develop three different cancers.


This may be because such contact allergies, where the body falsely believes it is under attack, help prime the immune system to fight off other threats. The team, led by Dr Kaare Engkilde, of Copenhagen University Hospital, studied a database of just under 17,000 adults who all undertook patch tests for common contact allergens between 1984 and 2008.

They found just over one in three or around 6,000 people, tested positive for at least one contact allergy. They then compared these results with data from the Danish Cancer Registry.


The researchers found there were significantly lower rates of breast and non-melanoma skin cancer in both sexes among those with contact allergies. There were also lower rates of brain cancer among women. Previous research has found people with allergies to pollen and house dust mites may be protected against the disease.  These findings back up the ‘immunosurveillance hypothesis,’ which holds that people with allergies are less likely to develop cancer because their immune systems are super responsive, say the authors.

‘Perhaps there’s some protective function and therefore, the immune system is perhaps more likely to fight off certain things, including cancers,’ Dr Clifford Basset at NYU Langone School of Medicine told ABC News.
The analysis also picked up higher rates of bladder cancer found among those with contact allergies, which might be the result of higher levels of chemical metabolites accumulated in the blood, they suggest. Writing in BMJ Open, the authors caution that it is too early to draw definitive conclusions about cause and effect.  They said further research will be needed to adjust for other risk factors such as social class and smoking.

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Latest research on Euphorbia peplus (Petty spurge, Radium weed or Cancer weed/chick weed) for treating actinic keratoses

This is the latest research from the company that bought Peplin which was developing  this plant extract to treat superficial skin cancers. I know many of my patients were using it.

Four Phase 3 Efficacy and Safety Studies of Ingenol Mebutate, an Investigational Treatment for Actinic Keratosis, Presented at World Congress of Dermatology

Ingenol mebutate is an investigational two-to-three day topical treatment for precancerous skin disease
Copenhagen, Denmark – June 6 2011 – Clinical data from four Phase 3 studies of ingenol mebutate gel, an investigational treatment for actinic keratosis, were presented publicly for the first time at the 22nd World Congress of Dermatology in Seoul.  Two of the studies evaluated the efficacy and safety of ingenol mebutate 0.05% applied once daily for two consecutive days to actinic keratoses (multiple lesions) on the body.  The other two studies evaluated the efficacy and safety of ingenol mebutate 0.015% applied once daily for three consecutive days to actinic keratoses on the face and scalp.  The primary endpoint for all four studies was complete clearance rate of actinic keratoses at the day 57 visit.

Actinic keratosis, caused by long-term UV exposure, is a precancerous skin condition, which can lead to squamous cell carcinoma, a non-melanoma form of skin cancer. “Since there is no way to predict which actinic keratoses will advance to skin cancer, early detection and treatment of lesions is critical,” said Mark Lebwohl, M.D., Professor and Chair, Department of Dermatology, Mount Sinai Medical Center in New York.

Face and Scalp Data 
Two of the studies compared ingenol mebutate 0.015% to a placebo (vehicle) applied once daily for three consecutive days to actinic keratoses on the face or scalp.  In the first study, after 57 days (about 8 weeks), complete clearance of actinic keratosis lesions occurred in 47% (67/142) of patients using ingenol mebutate and 5% (7/136) of patients using placebo (P<0.001). The median reduction in total number of lesions from baseline was 87%.1 The second study found complete clearance in 37% (50/135) of patients in the ingenol mebutate group and 2% (3/134) of patients in the vehicle group (P<0.001).2

The most frequently reported local skin responses in the face and scalp studies were erythema (redness), flaking/scaling, and crusting, which peaked on day 4 and returned to below baseline by day 29; 1.  The most common treatment related adverse events were mild or moderate application-site reactions of pain 19% (25/132) and pruritus 11% (14/132); 2% of patients (3) experienced adverse events classified as severe. Treatment adherence was high;  99% and  96% of patients in the active treatment group completed therapy in the respective studies1, 2.

Body Data 
The other two studies compared ingenol mebutate 0.05% to a placebo gel (vehicle) applied once daily for two consecutive days to actinic keratoses on the body (arm, chest, back of the hand, leg, back or shoulder).  In the first study, after 57 days, complete clearance of actinic keratosis lesions occurred in 28% (35/126) of patients using ingenol mebutate and 5% (6/129) of patients using  placebo (P<0.0001).3 The second study found complete clearance of actinic keratosis lesions in 42% (42/100) of patients in the ingenol mebutate group and 5% (5/103) of patients in the vehicle group (P<0.001).4

The most frequently reported local skin responses in the body studies were erythema (redness) and flaking/scaling, which peaked between days 3 and 8  returning to  baseline at day 573,4. Adverse events were generally mild to moderate  resolving by day 573. The most common treatment related adverse events were application-site irritation and itching3. All local skin responses and treatment-related application-site adverse events resolved without sequelae4.

About Ingenol Mebutate
Ingenol mebutate is a topical gel derived from the Euphorbia peplus plant, and is being studied for its effect on actinic keratosis.  Data from the four studies were submitted to the United States Food and Drug Administration (FDA) as part of the New Drug Application (NDA) by LEO Pharma.

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Merkel cell carcinoma is more deadly than melanoma

This was in the Sydney Morning Herald today:

Rare skin cancer touted as most lethal

Belinda Tasker, AAP National Medical Correspondent

July 8, 2011 – 1:04PM


Move over melanoma, a little known form of skin cancer has taken the dubious title of being the most deadly form of the disease.

Scientists in Western Australia discovered that survival rates for people with merkel cell carcinoma (MCC) were far worse than those for melanoma, which has been widely regarded as the most lethal skin cancer.

They also found that WA had the highest rates of MCC in the world, with 215 cases diagnosed between 1993 and 2007.

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Of those cases, just 64 per cent of patients were still alive after five years compared to 90 per cent of those with melanoma.

Lead researcher Professor Lin Fritschi, of the WA Institute for Medical Research, said while MCC was an aggressive form of skin cancer it was still relatively uncommon.

“We don’t want everyone worried because we had 215 cases in 13 years,” she told AAP.

“There’s 1000 melanomas a year in WA so it’s nowhere near as common as melanoma.

“But it’s not well diagnosed and it’s quite aggressive and it has a high mortality compared to other skin cancers.”

MCCs take the form of pink lumps on the skin – compared to melanomas which are blackish in colour – and are most often found on the face, neck, arm and lower leg.

Like melanomas, MCCs are believed to be caused by sun exposure.

Those most likely to develop MCCs are older men, people with a history of skin cancer and those with suppressed immune systems due to liver and kidney transplants.

Prof Fritschi said that MCCs were often mistaken for the less aggressive and most common form of skin cancer, basel cell carcinomas (BCCs).

However, even when they were correctly diagnosed, removed and the patient treated with radiotherapy, the tumours were still prone to reappear.

“I don’t think doctors would see them often compared to BCCs and SCCs (squamous cell carcinoma, which are non-melanoma skin cancers),” Prof Fritschi said.

“Most red lumps on your skin are not going to be MCC but it’s something for doctors to keep aware of.”

The study by Prof Fritschi and her research colleagues has been accepted for publication in the British Journal of Dermatology.

They based their findings on a review of the WA Cancer Registry and now plan to expand their study to look at MCC rates across Australia.

The team said MCCs were not widely studied despite Australia having the highest rates of sun-related cancers in the world.

“Given the potential link between sun exposure and MCC incidence, it might be predicted that MCC rates in Australia would be high,” they wrote.

The researchers said there was some evidence that MCC rates leapt in the 1980s before stabilising in the late 1990s.

But they were not sure if the reported increases were real or the result of improved diagnosis.

They also added that while there was some suggestion of a link between MCCs and a newly-discovered viral infection, sun exposure was probably a greater risk factor in Australia.


Skin cancer phone apps

There has been a spate of new iphone apps designed to help with skin cancer diagnosis. Here is a list of a few with some reviews below. I have also come across a few that assist in determining UV radiation exposure at the location of the iphone. Let us know of any other useful skin cancer related iphone apps.


  1. Skinscan
  2. Lovemyskin
  3. Skin prevention
  4. Skin of mine


Can you diagnose cancer with an app? Skin Scan aims to find out

  • PRICE: $4.99
  • TASTY: If a mole can be analyzed, the app uses an algorithm to classify a mole’s risk level.
  • BUMMER: The app requires precision images, so you’ll probably have to snap a few before the images will analyze — if they do at all.
  • COOL: Save scanned images for later comparison.

If you hate going to the doctor, you’ll be thrilled to hear that app developer Skin Scan wants to help you replace that initial visit to the dermatologist. The Romania-based company behind Skin Scan: Your Pocket Scan Technology for Skin Cancer Prevention was recently awarded €50,000 from Seedmoney to continue work on its algorithm-based diagnostic app. For my money — the sale price of $4.99, for now — I’m still skeptical of relying on an app as a serious medical instrument, but if your alternative is not seeing a doctor at all, the app could be a worthy investment if you’re worried about a mole.

Using your iPhone’s camera — the app claims to support all iDevices, but I can’t imagine a camera of lesser quality than iPhone 4’s working — Skin Scan will analyze an image of a mole to determine its risk level. The trickiest part of Skin Scan is taking the photo. The app requires precise images, well-lit and free of hair or other interferences. Scanning takes a bit of time, and you won’t know if your image is acceptable until the process is complete. When taking the photo, it’s imperative you hold your iPhone steady and that you tap the screen to focus on the intended area. Getting the proper positioning probably will take some practice, and if you have a friend nearby, you’d do well to ask for help since holding the phone yourself might create a shadow. After you’ve snapped the photo, you’ll need to center and zoom in on the mole in the red box. Then you’ll be ready to scan.

If your image is readable, Skin Scan will calculate the mole’s fractals to estimate if it’s developing abnormally. Using what is already known about melanomas, the app will determine the mole’s risk level and if a doctor’s visit is necessary. One of my tests came back with a medium risk result (meaning I should keep an eye on it), which is when the archiving feature comes in handy. Skin Scan will save your analyzed images for future reference, giving you the ability to track a mole’s development. If anything, this is the app’s most-useful feature. Again, this is all dependent on successfully taking a scan-able photo — and yes, it is that difficult.

Of course, Skin Scan can’t replace good old-fashioned medicine, and its results should not be taken as infallible. Skin Scan is an app to watch, though, and is perhaps ushering in a new wave of usefulness when it comes to iDevices.


Adventure app:

With the arrival of summer comes more days spent kayaking on the water and exploring new hiking trails all while heightening your risk of developing skin cancer, thanks to the sun’s dangerous UV rays.

It’s often not enough to just use sunscreen; you have to be vigilant about checking your body for any possible cancerous moles or bumps. Luckily, there’s now an app for that. With the mobile app, users can take a picture of any worrisome skin condition including psoriasis, acne, sunburns and bug bites and upload it instantly for an automatic analysis.

The site does this by comparing your photo mathematically to another of its kind and comparing the differences. This feature of the app is great if you’re not sure you should make an actual trip to the doctor’s office yet. It’s an easy and not to mention free way to get quick medical advice.

If you want your photo looked at by a medical professional, you’ll have to pay $40 to $60 and wait about 24 hours. However, given that average wait time for a dermatologist appointment is about three months, waiting one day can hardly be seen as a downside.

This app is also a great way to get affordable medical advice if you don’t have health insurance and can’t afford to visit an actual dermatologist. Whether you need a quick consultation or advice from an actual doctor, is a great tool to keep yourself health and skin cancer-free this summer.

The Skinofmine iPhone app can be downloaded from for $2.99.


LoveMySkin presents four views of the body and allows you to add markings that you want to keep track of.  Zoom in and around a detailed rendering of the human anatomy (that explains the 17+ rating, unfortunately).  Tap a spot to add a mole marking. You can edit the details of each mole and keep notes on growth or changes.  A built-in guide makes comparing benign moles to malignant moles easier, though nothing replaces the opinion of a professional.  The idea is to get familiar with your body so that you know what’s normal and abnormal for you.  Skin cancer is a deadly disease, but awareness and a proactive attitude can make all the difference in early detection.


You can toggle between a male and female body, and any moles you’ve added to each one are saved (so, a male and female could share a copy of the app).


Single tap: add a new mole
Double tap: toggle highlight overlay
Two-finger tap: revert to normal zoom levels
Pinching: zooms in and out
Skin of Mine

This involves an online submission of a photo with a fee paid for a consultation by a deramtologist


Calcium and Vitamin D reduces melanoma risk in high risk patients

Hi all

Have a look at this study from the Journal of Clinical Oncology. Obviously it is only a very limited subset but is still quite interesting. A commentary from USA Today in underneath.

Ian Katz


Calcium Plus Vitamin D Supplementation and the Risk of Nonmelanoma and Melanoma Skin Cancer: Post Hoc Analyses of the Women’s Health Initiative Randomized Controlled Trial

Purpose In light of inverse relationships reported in observational studies of vitamin D intake and serum 25-hydroxyvitamin D levels with risk of nonmelanoma skin cancer (NMSC) and melanoma, we evaluated the effects of vitamin D combined with calcium supplementation on skin cancer in a randomized placebo-controlled trial.


Methods Postmenopausal women age 50 to 79 years (N = 36,282) enrolled onto the Women’s Health Initiative (WHI) calcium/vitamin D clinical trial were randomly assigned to receive 1,000 mg of elemental calcium plus 400 IU of vitamin D3 (CaD) daily or placebo for a mean follow-up period of 7.0 years. NMSC and melanoma skin cancers were ascertained by annual self-report; melanoma skin cancers underwent physician adjudication.


Results Neither incident NMSC nor melanoma rates differed between treatment (hazard ratio [HR], 1.02; 95% CI, 0.95 to 1.07) and placebo groups (HR, 0.86; 95% CI, 0.64 to 1.16). In subgroup analyses, women with history of NMSC assigned to CaD had a reduced risk of melanoma versus those receiving placebo (HR, 0.43; 95% CI, 0.21 to 0.90; Pinteraction = .038), which was not observed in women without history of NMSC.


Conclusion Vitamin D supplementation at a relatively low dose plus calcium did not reduce the overall incidence of NMSC or melanoma. However, in women with history of NMSC, CaD supplementation reduced melanoma risk, suggesting a potential role for calcium and vitamin D supplements in this high-risk group. Results from this post hoc subgroup analysis should be interpreted with caution but warrant additional investigation.


Commentary from USA today:

Certain women at risk for developing melanoma, the most severe form of skin cancer, may cut the likelihood in half by taking vitamin D/calcium supplements, a new study suggests.


“It looks like there is some promising evidence for vitamin D and calcium for prevention of melanoma in a high-risk group,” said lead researcher Dr. Jean Tang, an assistant professor of dermatology at Stanford University School of Medicine.


The women most at risk of developing the life-threatening cancer are those who have had a previous non-melanoma form of skin cancer, such as basal cell or squamous cell cancer, the researchers said.

Vitamin D and calcium are well-known for their roles in bone growth, but they also affect other cells in the body. Some studies have shown that vitamin D and calcium are associated with lower risk of colon, breast, prostate and other cancers, the researchers said.


Tang speculated that cancer cells lurking in the skin of women who have had a previous skin cancer may be waiting to develop into melanoma. “But if they take calcium and vitamin D that reduces the risk of developing an actual tumor,” she said. As little as 400 international units (IU) of vitamin D daily may be protective, Tang said. The U.S. Institute of Medicine now recommends 600 IU of vitamin D daily, she added.


Calcium has also been shown to reduce tumor growth in patients with colon cancer, Tang said. “So maybe calcium has a role, too,” she said. “I can’t say whether it was the calcium or the vitamin D that was important.”But the combination seemed to convey a benefit, she added.


Whether these results would be seen in men or young women isn’t known, Tang noted. But an earlier study led by Tang found a benefit from vitamin D in reducing the risk of melanoma among older men.

“More studies need to be done, because we want to make sure these results are true in other communities,” Tang said.


The report was published in the June 27 online edition of the Journal of Clinical Oncology.

For the study, Tang’s team collected data on 36,282 postmenopausal women, 50 to 79 years old, who took part in the Women’s Health Initiative study. As part of a test to see if calcium plus vitamin D had any effect on hip fractures or colon cancer, the women were randomly assigned to take supplements or placebo.


The supplements were 1,000 milligrams of calcium and 400 IU of vitamin D daily. Over about seven years of follow-up, the women taking the supplements who had had previous non-melanoma skin cancer reduced their risk of developing melanoma by 57 percent, compared with similar women not taking the supplements. The melanoma risk reduction was not seen among women who had not had an earlier non-melanoma skin cancer, the study authors noted.


Hoping to uncover why vitamin D and/or calcium may be beneficial, Tang said the team next intends to test the compounds directly on cancer cells.  Commenting on the study, Dr. Michael Holick, professor of medicine, physiology and biophysics at Boston University School of Medicine, said a lot of sun exposure early in life increases the risk for non-melanoma skin cancer, but may actually lower the risk of developing melanoma. Sunlight is a source of vitamin D.


“Melanoma is a different story. Being exposed to sunlight, making some vitamin D may very well be protective of melanoma,” Holick said. “The thinking is, improving your vitamin D status, whether by supplements or by exposure to sunlight, you are providing your skin cells with a mechanism to prevent them from becoming malignant,” he said.


What role calcium may play is unknown, Holick said. “We don’t know whether vitamin D can have its effect in the absence of calcium or vice versa; there’s rationale for both,” he said. Holick said he thinks the finding would be the same for men and other groups. People can get their vitamin D from diet, sun exposure and supplements. Fatty fish and fortified dairy products are two dietary sources of vitamin D. Holick said he recommends that children take 1,000 IU of vitamin D a day and adults, 2,000 IU.


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