Archive for February, 2012

MELANOMA PASSES FROM MOTHER TO CHILD VIA PLACENTA

This is a rare occurrence but is in the literature as one of the only tumours to pass across the placenta.

Dr Ian Katz

 

Melanoma Passes From Mother To Unborn
Malignant Melanoma is known to be highly aggressive, spreading rapidly to other parts of the body if left untreated. It’s extremely rare, however, for it to be able to pass to an unborn fetus. This is what appears to have happened in the case of Briana Cox, who had malignant skin melanoma removed in 2006.

Doctors were sure that the cancer had been stopped in time, and Briana was given the all clear, going on to have a son David, who is now three, and a daughter Addison, in June 2011. Sadly, just two months after the birth, Briana collapsed while jogging, and was found to have advanced cancer in many parts of her body, including her brain.

In September 2011, four dark patches appeared on her baby Addison’s forehead and visits to the doctor led to a diagnosis of stage four melanoma. Her mother, Briana, died in February at the age of 33, from advanced metastasized cancer, but was determined to tell the painful story of how the cancer had spread to her unborn baby.

Doctors have been flummoxed as to how the metastasized cancer was able to pass across the placenta to the developing fetus. Dr. Pooja Hingorani, a pediatric oncologist who is now treating Addison at Phoenix Children’s Hospital, confirmed that the number of documented cases of something like this occurring is miniscule.

Here is a link to the rest of the discussion:

http://www.medicalnewstoday.com/articles/242326.php

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More on Apps for skin cancer detection

This really sems to be taking off. This article is from Columbia University.

 

Can An App Spot Skin Cancer?

BY KIMBERLY DRELICH

Is that a benign freckle or a cancerous mole?

 

A iPhone mole-scanning demonstration. Is that a benign freckle or a cancerous mole?

To answer that question quickly, a flurry of skin-scanning, smartphone apps has emerged where people can now snap photos of their skin moles for analysis — and let an app decide the danger.

Mole-scanning apps differ in quality and approach. Some, such as MelApp and Skin Scan, have algorithms to detect growth and enable users to photograph and track moles over time, as well as locate a doctor.  Other apps allow users to map the parts of the body where moles are located.  With Mole Detective, users take a photo of a mole, which the app then analyzes by the “ABCDE” method, which examines factors such as asymmetry and diameter.  In a separate category is an app called SpotCheck, which allows users in California, New York and New Jersey to photograph a mole and send the photo to certified dermatologists for analysis of potential abnormalities.  The patient receives a response within 24 hours, and, if the mole appears abnormal, the app then recommends a doctor in the patient’s area.

At first glance, a skin-scanning app would seem an unreliable way to form a possible cancer diagnosis. The apps include disclaimers that they don’t replace medical treatment and are not diagnostic tools, but some apps still claim to be a medical device. For example, Skin Scan’s site states it “is a medical application created for you to easily scan and monitor your moles over time in order to prevent skin cancer.”

They’re not currently regulated by the Food and Drug Administration. But because they inhabit a new realm where phones become tools to analyze skin, they’ve made inroads to consumers. Still, not all dermatologists embrace them.

Dr. Laura Ferris, a dermatologist at the University of Pittsburgh Medical Center, said it could be challenging to take an accurate photo or judge a mole without seeing the patient’s entire skin and other moles.  “I think it is hard to look at one lesion out of the context of a patient,” she said. “It’s not always the lesion that sends someone in the door that turns out to be the skin cancer.”

Ferris, who gives her patients a full skin exam, uses a dermatoscope to further examine lesions and will generally biopsy a mole of concern.  While patient-directed apps don’t incorporate dermatological tools, such as hand-held scopes for examining lesions, a dermatoscope can be attached to a smartphone, but those apps are not currently aimed at patients.

Many of the apps focus on melanoma, a type of skin cancer that can be effectively treated with early detection. The Skin Cancer Foundation cites one study showing that the survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent. According to the foundation, another study has shown that the survival rate falls to 15 percent for those with advanced disease. The foundation’s website states that an estimated 8,790 people die of melanoma yearly in the United States.  The American Cancer Society web site recommends self-exams and that people show moles to their doctors.

Despite their disclaimers, the apps’ marketing could blur that distinction and cause potential consumer confusion. The Skin Scan App’s iTunes page states Skin Scan is “the Most Accurate Skin Cancer Detector.” “MelApp is an image-based risk assessment mobile app that assists in the early detection of melanoma,” its website says.

Dr. Barney Kenet, a New York City dermatologist and author of “Saving Your Skin,” considers anything that spurs people to examine their skin as a plus.  “Anything that gets people looking at their skin, ultimately brings patients into dermatologists’ offices,” Kenet says.

But Kenet warned the apps can’t give an exact diagnosis.  He acknowledged that people could possibly decide not to go to a doctor, if the mole is deemed low-risk by the app — a problematic result, if the mole is in fact at greater risk.

Kristi Zuhlke, founder and CEO of Mole Detective, decided to develop the mole-analyzing app based on her experience examining the moles of her boyfriend, a stage 4 melanoma survivor.  In between her boyfriend’s doctor visits, she would check the moles on his back and she realized she needed a tool to help track if they changed.

She said she intends the app to raise awareness of melanoma and motivate people to visit the dermatologist. Even if the app gives a “green” diagnosis that the mole is not showing signs of melanoma, Zuhlke said the app still encourages people to make their annual appointment.  She said that if the user takes a photo in the right lighting, the app is accurate.  The app also has an alarm feature to remind people, who might put it off, to examine their skin. “The intent is by no means to diagnose,” she said, “but to help people understand they need to go to the dermatologist.”

In a different category of analysis is SpotCheck, in which dermatologists analyze photos captured by devices.  Dr. Bobby Buka, founder of SpotCheck, could not be reached for comment regarding his app, but he noted in an ABC News interview that while the average wait time to see a dermatologist is 38 days, dermatologists within the SpotCheck network can see patients within two weeks.

The companies that developed MelApp and Skin Scan also could not be reached for comment.

Dr. Thomas Hornyak, chief of dermatology at the VA Maryland Health Care System and associate professor of dermatology and of biochemistry and molecular biology at the University of Maryland School of Medicine, emphasized that it’s important to fully assess a person’s skin and risk factors.  “Just focusing on the moles isn’t enough,” he said. “That’s why I think, at this stage, the role for remote imaging done from one’s own hand is pretty limited and in its infancy.”

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Skin Cancer Frequency in Chronic Leg Ulcers >10 Percent

This came through my inbox today. I find this sort of information very useful in deciding how to manage chronic ulcers and when to think about biopsy.

regards

Ian

 

Chronic leg ulcers that don’t heal after three months of appropriate treatment have an overall skin cancer frequency of 10.4 percent, according to a study published online Feb. 20 in the Archives of Dermatology

 

WEDNESDAY, Feb. 22 (HealthDay News) — Chronic leg ulcers (CLUs) that don’t heal after three months of appropriate treatment have an overall skin cancer frequency of 10.4 percent, according to a study published online Feb. 20 in the Archives of Dermatology.

To investigate the frequency of skin cancers associated with CLUs, Patricia Senet, M.D., of Université Paris X, and colleagues studied 144 ambulatory or hospitalized patients with 154 CLUs attributed to venous and/or peripheral arterial disease(s), with increasing wound size (area and/or depth), despite receiving appropriate standard treatment for at least three months. Upon inclusion in the study, at least two 6-mm punch biopsies (one at the wound edge and one in the wound bed) were systematically performed.

The researchers found that the overall frequency of skin cancer in the CLUs was 10.4 percent; with nine squamous cell carcinomas, five basal cell carcinomas, one melanoma, and one leiomyosarcoma. More than half (56.3 percent) had persisted for at least three years. Older age, abnormal excessive granulation tissue at the wound edges, high clinical suspicion of cancer, and number of biopsies were significantly associated with skin cancer on univariate analysis. Neither wound area or duration, were significantly associated with skin cancer.

“The combined primary ulcerated cancer or malignant transformation frequency was sufficiently high in CLUs referred to tertiary care centers to consider systematic biopsy of a wound refractory to three months or more of appropriate treatment,” write the authors.

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Sunscreen use in kids

Hi All

I found this fascinating (see the full abstract below):

 

Sunscreen application in kids: pump dispenser is best but most kids still do not apply sufficient sunscreen

 

Much like adults, school children apply sunscreen substantially less than is recommended although the pump has been highlighted as the best dispenser for the products, according to a study in Australia.

The objective was to measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the recommended thickness of 2mg/ cm2,  as well as to investigate how application thickness was influenced by age of the child  and by dispenser type (500-mL pump, 125-mL squeeze bottle, or 50-mL roll-on).

The results showed that children applied their sunscreen at a median thickness of 0.48 mg/cm2. Children applied significantly more sunscreen when using the pump (0.75 mg/cm2) and the squeeze bottle (0.57 mg/cm2) compared with the roll-on (0.22 mg/cm2) (P < .001 for both).

The study concluded that, regardless of age, primary schoolchildren apply sunscreen at substantially less than the recommended rate (and in fact much less than 1.00 mg/cm2, similar to what has been observed among adults). Some sunscreen dispensers seem to facilitate thicker application than others.

As usual, comments greatly appreciated – email me at Ian.katz@southernsun.com.au

Regards

Ian Katz

 

The Children and Sunscreen Study

A Crossover Trial Investigating Children’s Sunscreen Application Thickness and the Influence of Age and Dispenser Type

Abbey Diaz, MAppSc; Rachel E. Neale, PhD; Michael G. Kimlin, PhD; Lee Jones, BStats; Monika Janda, PhD 

Arch Dermatol. Published online January 16, 2012. doi:10.1001/archdermatol.2011.2586

Objectives  To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm2) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL squeeze bottle, or 50-mL roll-on).

Design  A crossover quasiexperimental study design comparing 3 sunscreen dispenser types.

Setting  Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia.

Participants  Children (n = 87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n = 258).

Intervention  Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week.

Main Outcome Measure  Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was divided by the coverage area of application (in square centimeters), which was calculated by multiplying the children’s body surface area by the percentage of the body covered with sunscreen.

Results  Children applied their sunscreen at a median thickness of 0.48 mg/cm2. Children applied significantly more sunscreen when using the pump (0.75 mg/cm2) and the squeeze bottle (0.57 mg/cm2) compared with the roll-on (0.22 mg/cm2) (P < .001 for both).

Conclusions  Regardless of age, primary schoolchildren apply sunscreen at substantially less than 1.00 mg/cm2, similar to what has been observed among adults. Some sunscreen dispensers seem to facilitate thicker application than others.

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Basal Cell Carcinoma at a Young Age: Another Consequence of Tanning Beds

Tanning bed users younger than 40 developed early-onset BCCs significantly more often than nonusers.

Over the past 4 decades, the incidence of basal cell carcinoma (BCC) has increased markedly, particularly in women under the age of 40. This increase coincides with the more frequent use by the public of tanning beds for cosmetic purposes. Estimates suggest as many as one third of teenagers in the U.S. have used tanning beds at least once, and 40% regularly use this means of tanning. Although good epidemiological evidence associates tanning bed use with cutaneous squamous cell carcinomas (SCCs) and melanomas, the effect on BCCs has been less certain. Investigators examined the development of BCCs in young tanning bed users.

The researchers compared interview responses by 376 patients with prior history of biopsy-proven BCC and 390 patients with other dermatological conditions (age, <40 in both groups). Men and women who had used indoor tanning beds at least once were significantly more likely than never-users to have early-onset BCC (BCC that develops before age 40; odds ratio, 1.69). The association between tanning bed use and early-onset BCC was greater in women than in men and greater in patients with multiple BCCs than in those with single BCCs. In multivariate analysis, this association grew stronger with increasing years of use. Researchers also identified a strong association between early-onset BCC and having had a tanning bed–induced burn. Compared with nonusers, tanning bed users were nearly four times more likely to have BCCs on the extremities and more than twice as likely to have BCCs on the trunk. Tanning bed users had no observable increase in BCCs on the head and neck, areas subject to considerably more ambient sun exposure. The authors estimated the percentages of early-onset BCCs that could have been prevented by tanning bed avoidance at 27% overall and 43% among women alone.

Comment: Few studies have evaluated the association between tanning bed exposure and basal cell carcinoma, and the results of existing studies are inconclusive because most included older individuals in the study population. This well-designed study was limited to assessment of the under-40 population that is most likely to use tanning beds. The observation that tanning bed use was associated with BCCs of the trunk and extremities highlights the importance of complete examinations of frequent tanning bed users, not only for BCCs but also for melanomas and squamous cell carcinomas of the skin.

 Craig A. Elmets, MD

Published in Journal Watch Dermatology February 3, 2012

Citation(s):

Ferrucci LM et al. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol2011 Dec 8; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.jaad.2011.11.940)

 

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FDA approves vismodegib for basal cell cancers

Hi All

This is very interesting. I am unaware of any other such treatment for BCC.  Although this is only for advanced tumours at this point,  it does point towards new treatment options in the future.

regards

Ian

 

The Food and Drug Administration has approved the groundbreaking, first-in-class drug Erivedge (vismodegib, Genentech) to treat adult patients with advanced and metastatic basal cell cancers.

Cleared under the FDA’s priority review program — which allows an expedited six-month evaluation of drugs that may offer major treatment advances — Erivedge is intended for use in patients with locally advanced basal cell cancer who are not candidates for surgery or radiation and for patients whose cancer has metastatized.

Erivedge is taken in pill form once a day. It works by inhibiting the Hedgehog pathway, which is active in most basal cell cancers and only a few normal tissues, such as hair follicles, according to the FDA website.

 

See http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=757288&cid=DERM for more about this.

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