Archive for February, 2013

Taking Omega-3 Supplements May Help Prevent Skin Cancer

This came out yesterday

Results of the study, funded by the Association for International Cancer Research, found that taking a regular dose of fish oils boosted skin immunity to sunlight. Specifically, it also reduced sunlight-induced suppression of the immune system, known as immunosuppression, which affects the body’s ability to fight skin cancer and infection. The findings have been published in The American Journal of Clinical Nutrition this month.

Professor Rhodes, who is based in the Photobiology Unit at the University’s School of Medicine and Salford Royal NHS Foundation Trust, said it was the first time the research had been carried out on humans. “There has been research in this area carried out on mice in the past but this is the first time that there has been a clinical trial directly in people,” she said. “It has taken a number of years to get to this stage and the findings are very exciting.

“This study adds to the evidence that omega-3 is a potential nutrient to protect against skin cancer. Although the changes we found when someone took the oil were small, they suggest that a continuous low level of chemoprevention from taking omega-3 could reduce the risk of skin cancer over an individual’s lifetime.”

Patients who volunteered for the trial took a 4g dose of omega-3, which is about one and a half portions of oily fish, daily and were then exposed to the equivalent of either 8, 15 or 30 minutes of summer midday sun in Manchester using a special light machine. Other patients took a placebo, before being exposed to the light machine. Immunosuppression was 50% lower in people who took the supplement and were exposed to 8 and 15 minutes of sun compared with people who did not take the supplement. The study showed little influence on those in the 30 minute group.

The findings are important in the battle against skin cancer because previous research has shown that sunscreens are often applied inadequately and only worn during holiday periods. However, Professor Rhodes stressed that the omega-3 was not a substitute for sunscreen and physical protection, and that omega-3 should be regarded as an additional small measure to help protect skin from sun damage. The fish oil has already been shown to have many beneficial health effects such as helping with cardiovascular disease, meaning taking the supplement could lead to a range of potential health benefits



Hyfrecators and Interference with Implantable Cardiac Devices

I have always wondered if this was an urban myth. It never stopped me using the hyfrecator before!



Investigation of Hyfrecators and Their In Vitro Interference with Implantable Cardiac Devices


BACKGROUND Guidelines exist for minimizing potential electromagnetic interference (EMI) with electrosurgical equipment in patients with cardiac rhythm management (CRM) devices. These guidelines encompass all electrosurgical devices but are not specific for hyfrecators.

OBJECTIVE To investigate the potential interference of CRM devices by hyfrecators.

MATERIALS AND METHODS Using a collagen-based saline gel, three implantable pulse generators (pacemakers) and three implantable cardioverter defibrillators were tested to measure the EMI from two commonly used hyfrecators. The six devices were tested using the hyfrecator under normal use settings and on maximum power.

RESULTS Hyfrecators did not interfere with defibrillators and affected pacemakers only when used in close proximity to the device. For the pacemakers, atrial inhibition was observed at a distance of 3 cm on maximum hyfrecator settings and 1 cm at normal use settings. Ventricular inhibition occurred in very close proximity to the device (<1 cm) or in direct contact.

CONCLUSION Hyfrecators are safe to use in patients with defibrillators and can be used in pacemaker patients within 2 inches of the device perimeter.


Vitamin D Level and Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma Risk

This is a great review of a complex topic. Let me know if you want a copy of the article.



Various associations between serum vitamin D levels and skin cancer have been reported. In this issue, van der Pols et al. observed that baseline 25-hydroxyvitamin D (25OHD) levels above 75 nmol/L were associated with an increased incidence of basal cell carcinoma and melanoma, and a nonstatistically significant decreased incidence of squamous cell carcinoma. Complex factors including sun exposure, skin phototype, and anticarcinogenic and procarcinogenic effects of vitamin D are potential causes of the observed associations.


Journal of Investigative Dermatology (2013) 133, 589–592. doi:10.1038/jid.2012.427


Transection and melanoma survival

I suppose this study supports what we already know




The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival

Mohsin Mir, MD, C. Stanley Chan, MD, Farhan Khan, MD, MBA, Bhuvaneswari Krishnan, MD,

Ida Orengo, MD, and Theodore Rosen, MD

Houston, Texas


Background: Depth of melanoma invasion is critical because it dictates patient treatment and prognosis.

Recent reports indicate melanoma transection with initial biopsy does not impact patient survival; however,

tumor transection can lead to misdiagnosis and inaccurate staging.


Objective: This study assessed the rate of melanoma transection with various biopsy techniques and the

impact of tumor transection on patient survival.


Methods: We conducted a retrospective review of all melanoma cases at our institution between 2000 and

2008. Of the 490 melanoma cases identified, 479 met inclusion criteria for the study. The transection rates of biopsy techniques were determined. Cases of transected tumors were matched with nontransected cases in a retrospective case-control fashion to evaluate survival.


Results: The rate of melanoma transection was 1.5% for excisional biopsies, 4.1% for punch biopsies, and

9.0% for saucerization biopsies. The means of disease-free survival for the control and transected groups

were 911 days and 832.7 days, respectively (P value .67). Overall survival for the control group was 1073.7

days versus 1012.4 days for the transected group (P value .72).


Limitations: The study used a select population. The sample size of transected biopsies was limited, in

turn limiting the power of the study. Residents performed the majority of biopsies.


Conclusion: Punch and saucerization biopsies were more likely to transect tumors than excisional

biopsies. The transection of melanoma did not affect overall disease-free survival or mortality in the

population studied. ( J Am Acad Dermatol 2013;68:452-8.)

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Desmoplastic Melanoma Review

This article is useful




Clinical and Dermoscopic Characteristics of Desmoplastic Melanomas

Objective: To describe and analyze the clinical and dermoscopic characteristics of desmoplastic melanoma (DM) as a function of pathologic subtype and phenotypic traits.

Design: Retrospective case series.

Setting: Eight high-risk dermatology clinics.

Patients: Patients with DM confirmed by histopathologic analysis whose records included a high-quality dermoscopic image.

Main Outcome Measures: Clinical, dermoscopic, and histopathologic features of DM.

Results: A total of 37DMcases were identified. The majority of patients had fair skin, few nevi, and no history

of melanoma. Lentigo maligna was the most frequent subtype of melanoma associated with DM. The most frequent clinical presentation of DM was a palpable and/or indurated lesion located on sun-exposed skin. Fortythree percent of cases were classified as pure DM, and 57% as mixed DM. Pure DM lesions were thicker than mixed DM lesions (4.10 vs 2.83 mm) (P=.22) and were less likely to have an associated epidermal non-DM component (63% vs 100%) (P=.004). Dermoscopically, DMs had at least 1 melanoma-specific structure, the most frequent being atypical vascular structures. Peppering was more frequently seen in pure DM (44% in pure DM vs 24% in mixed DM) (P=.29). In contrast, crystalline structures, polymorphous vessels, and vascular blush were more commonly seen in mixed DM.

Conclusions: Though DM can be difficult to diagnose based on clinical morphologic characteristics alone, dermoscopy has proved to be a useful aid during the evaluation of clinically equivocal lesions or those lesions with a benign appearance. The most common dermoscopic clues observed in DMs included atypical vascular structures, peppering, and occasionally other melanoma specific structures.

JAMA Dermatol.

Published online January 16, 2013.