Melanoma staging app

Came across this the other day which may be useful to some

http://itunes.apple.com/au/app/melanoma-staging-calculator/id424646329?mt=8

regards

Ian

Description from website

The Dermatologic Cooperative Oncology Group (DECOG) developed the first free iPhone app for staging cutaneous melanoma patients according to the AJCC 2009 classification system. After entering data like tumor thickness, ulceration, mitotic rate, micro/macrometastases of lymph nodes as well as data for distant metastases the current TNM classification, clinical staging and average 5-year overall survival is calculated. Results can be transferred by e-mail on request.

Through a link to the DECOG homepage further information is provided (treatment guidelines, clinical trials registry).

This app is designed for physicians to simplify the classification of melanoma patients. Prognostic data is average and does not reflect the individual course of the patient. This app cannot substitute a consultation with your treating physician.

 

D is for diet and limited doses of sun

Hi there

This was in the Sydney Morning Herald this weekend and patients may ask you about it.

regards

Ian

Vitamin D deficiencies are harmful but, as Nicole Hasham explains, debate rages over its intake.

Susan Torres wasn’t just aware of the risk – it was her life’s work. But even as the nutrition lecturer sat through countless conferences warning of the dangers of vitamin D deficiency, it never dawned that she was the perfect case study.

She has the risk factors: sun-shy and office-bound. But it wasn’t until her naturopath suggested a blood test that the 41-year-old discovered her body was lacking in the vital hormone.

Read more: http://www.smh.com.au/lifestyle/diet-and-fitness/d-is-for-diet-and-limited-doses-of-sun-20120622-20tc8.html#ixzz1ylCnzpyh

via D is for diet and limited doses of sun.

Smoking Might Raise Your Odds for Skin Cancer – US News and World Report

Smoking Might Raise Your Odds for Skin Cancer – US News and World Report.

Could Sunlight Lower Your Odds for Pancreatic Cancer? – US News and World Report

Could Sunlight Lower Your Odds for Pancreatic Cancer? – US News and World Report.

Great new dermpath app

Hi all 

Have a look at this if you are interested in dermpath.

http://itunes.apple.com/us/app/mydermpath/id455500880?mt=8

regards

Ian

PDT for Basal Cell Carcinoma: A Long-Term Follow-Up

This was in journal watch. Does anyone use DMSO?

regards

Ian

Long-term results show 5-aminolevulinic acid photodynamic therapy to be beneficial for basal cell carcinomas when surgery is not a good option.

Although surgical removal is the mainstay of basal cell carcinoma (BCC) therapy, additional options are desirable in some situations. One alternative is 5-aminolevulinic acid photodynamic therapy (ALA-PDT), but data are scarce concerning which BCC types are amenable to this treatment and long-term outcomes. In this study, investigators treated 60 BCCs in 44 patients with one or two sessions of ALA-PDT and followed them for 10 years. Morpheaform and pigmented BCCs were excluded from treatment, but recurrent lesions were included. The protocol involved debulking of the tumor, treatment with the drug penetration enhancer dimethylsulfoxide (DMSO) for 5 minutes, followed by ALA-PDT. ALA was activated by a broadband light unit with an emission spectrum in the 550–700 nm range.

The 10-year complete response rates were 87% with two treatment sessions and 60% with one session. All recurrences developed within 3 years of treatment. At 10 years, 90% of the primary tumors were recurrence free, but ALA-PDT was effective for only two of the five recurrent tumors. Recurrences were more likely in men. Physician evaluators considered the cosmetic outcome to be excellent or good in 90% of treated sites at 1 year and in 100% at 10 years.

Comment: Long-term results with 5-aminolevulinic acid photodynamic therapy for basal cell carcinomas are very positive — comparable to other nonsurgical interventions. Longer-wavelength light sources in the 625-nm range (as used in this study) are probably the best choice for BCC treatment, because they penetrate more deeply into the skin than shorter-wavelength blue lights. The authors speculate that DMSO may have contributed to efficacy by augmenting conversion of ALA to its active metabolite. Dermatologists may wish to consider ALA-PDT for primary BCCs when surgical procedures should be avoided.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology June 15, 2012

CITATION(S):

Christensen E et al. High and sustained efficacy after two sessions of topical 5-aminolaevulinic acid photodynamic therapy for basal cell carcinoma: A prospective, clinical and histological 10-year follow-up study. Br J Dermatol 2012 Jun; 166:1342.

• Medline abstract (Free)

New drug shows promise against rare skin cancer

I have mentioned this before. I wonder if it would be useful in our regular patients who can have more than 10 BCC’s a year?

Ian

 

A NEWLY approved drug has shown promise in keeping two rare variations of skin cancer at bay, according to research published in the New England Journal of Medicine recently.

The drug, Erivedge (vismodegib), is made by Genentech, a US subsidiary of the Swiss drug giant Roche, and was approved by the US Food and Drug Administration in January after an expedited review.

It aims to treat basal cell carcinoma, which is the most common form of skin cancer in the world but which is rarely deadly. Basal cell carcinoma accounts for 80 per cent of nonmelanoma cancers and some two million new cases in the US each year.

The journal published two studies that show how it helped some patients with two unusual variations of basal cell carcinoma: metastatic basal cell carcinoma and Gorlin syndrome, also known as Basal Cell Nevus Syndrome.

There is no other treatment for Gorlin syndrome, which strikes one in 50,000 people and involves the constant growth of tumours, which are often not deadly but can cause scarring and require frequent surgeries. Subjects with Gorlin syndrome who took vismodegib developed an average of two new tumors per year, compared with 29 new tumors in subjects taking a placebo, the study said.

When it came to people whose basal cell carcinoma had spread, the study showed 30 per cent of 33 patients with metastatic basal cell carcinoma responded to treatment, meaning their tumors shrank. Forty-three per cent of 63 subjects with locally advanced basal cell carcinoma responded in kind.

The phase II study showed a median progression-free survival time of 9.5 months, but overall survival rates have not yet been established. “It is a landmark day for patients with basal cell carcinoma and all those involved in their care — the greatest advance in therapy yet seen for this disease,” said an accompanying editorial by John Lear, consultant dermatologist at Manchester Royal Infirmary in Britain.

However, he pointed out the high rate of adverse effects, including loss of taste, hair loss and muscle cramps, which led to a high rate of people dropping out of the study early.

“Side effects are considerable and frequent, resulting in high rates of drug discontinuation, and these rates will probably be even higher in clinical practice,” Lear said.

More study is needed to determine how long the drug may work to ward off cancer, what populations it may best serve, and when it should be optimally administered, he added.

Early Childhood Neglect May Raise Risk of Adult Skin Cancer

I found this fascinating, especially the bit about how people who have had a stressful event in the last year are more at risk of skin cancer. I think we do see this. The childhood bit I am not sure about…

regards

Ian

 

Skin cancer patients whose childhood included periods of neglect or maltreatment are at a much greater risk for their cancers to return when they face a major stressful event, based on a new study.

The research suggests that such experiences during a person’s youth can set a lower level of immune response for life, which in turn might make them more susceptible to the kind of cancers that are often successfully fought by the immune system, so-called immunogenic tumors.

While the research focused on patients with a fairly benign form of skin cancer—basal cell carcinoma (BCC)—the findings appear as a warning for patients to be more vigilant in concerns over their health for the rest of their lives.

The study appears in the June 4, 2012, issue of the journal Archives of General Psychiatry and is the latest in three decades of research linking stress and immunity that have been led by investigators at Ohio State University’s Institute for Behavioral Medicine Research (IBMR).

“This is the first study to show that troubled early parental experiences, in combination with a severe life event in the past year, predict local immune responses to a BCC tumor,” wrote Christopher Fagundes, first author of the paper and a postdoctoral fellow at the IBMR.

“This expands the growing evidence that the consequences of early parental experiences extend well beyond childhood.”

Basal cell tumors are considered the most common form of skin cancer, and much less dangerous than squamous cell carcinomas or melanomas. And their frequency is on the rise, the number having doubled in the United States every 14 years. Nearly half of all BCC patients will have an additional tumor form within three years of their first.

The researchers looked at 91 men and women who previously had a BCC. Each of the participants were given a battery of surveys and interviews, some of which gauged their past relationship with their parents as children. From this, the researchers could measure the degree of neglect or maltreatment the patients had experienced as children.

Tissue from each participant’s tumors was also analyzed and tested for the presence of four types of messenger RNA, markers that measured the intensity of the person’s immune response to their tumor.

The results showed that BCC patients who had a severe, stressful life event in the last year, and who experienced neglect or maltreatment from their mothers as children, had a substantial drop in their immune response to the tumors.

“Those in the top 25 percent of maltreatment by their mothers saw a 350 percent reduction in immunity compared to those in the bottom 25 percent of maltreatment,” Fagundes explained.

Maltreatment or neglect from the father showed a 140 percent drop in immunity when the top 25 percent were compared to the bottom 25 percent, he said.

“We’re not talking about abuse here,” he explained. “And the effects were similar regardless of whether the harm came from the mother or father.”

Jan Kiecolt-Glaser, co-author of the paper and a professor of psychiatry and psychology at Ohio State, said, “This means that for people who have had an early history of vulnerability and who are currently going through a stressful period, they have another reason to watch their health and be especially vigilant.”

The findings are likely to be significant beyond just their role with BCC patients, said Ron Glaser, another co-author and director of the IBMR. Glaser, a professor of molecular virology, immunology and medical genetics, pointed to other immunogenic cancers that might be affected.

“If the immune system is down-regulated, it will affect a person’s ability to deal with that tumor,” he said. “Some examples of other immunogenic tumors include ovarian cancer, head and neck cancers, melanoma, some lymphomas and tumors induced by cancer viruses, and renal cell tumors.”

The researchers hope to continue the work and determine what mechanisms are responsible for the continued lower immune response.