Some new interesting articles

Came across these in the last couple of days. They are also available on the linkedin skin cancer doctor group which you should feel free to join.


Ian (men and women variation with melanoma)



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Dermoscopy characterized as patient trust builder

Hi there


I found this interesting.





Skin Cancer Tx No Help for Sick Older Patients?

Hi There

All pretty obvious actually




  • Surgical treatment of nonmelanoma skin cancer in elderly patients with other underlying health conditions may do more harm than good, researchers found.Surgical treatment of nonmelanoma skin cancer in elderly patients with other underlying health conditions may do more harm than good.
  • Note that 43% of patients with limited life expectancy and  nonmelanoma skin cancer died within 5 years of the study baseline from complications unrelated to their skin cancer.

In a cohort of nonmelanoma skin cancer patients, those with limited life expectancy experienced more complications with therapy (20%) than those who did not have limited life expectancy (15%), according to Eleni Linos, MD, DrPH, of the University of California San Francisco, and colleagues.

In addition, 43% of patients with limited life expectancy and nonmelanoma skin cancer died within 5 years of the study baseline from complications unrelated to their skin cancer, such as heart disease, prostate cancer, and Alzheimer’s disease, they wrote online inJAMA Internal Medicine.

Patients were considered of limited life expectancy if they were 85-years-old or older or if they had a Charlson Comorbidity Index score of 3 or greater, the authors explained.

Nonmelanoma skin cancers “grow slowly, rarely metastasize or affect survival, and typically do not result in significant morbidity or diminished quality of life.” These tumors are often asymptomatic “and patients are often unaware of them,” the authors said, adding that treatment for nonmelanoma skin cancer is meant to prevent expansion and local recurrence of the tumor.

They also noted that nonmelanoma skin cancer is the fifth most costly cancer for Medicare.

The researchers compared treatment patterns and clinical outcomes in patients with nonmelanoma skin cancer who were of limited life expectancy with patients who were not of limited life expectancy at two California dermatology clinics (one private and one university-affiliated Veterans Administration program).

Treatment options included elliptical excision, chemosurgery (Mohs surgery), tumor destruction, and no treatment. Overall, 68.7% of tumors underwent surgery.

Data were collected through clinician notes and pathology records.

The patient population included 1,360 patients with 1,739 tumors, including 332 patients with 428 tumors who were of limited life expectancy. Median patient age was 69 years. Most participants were male (72.7%) and had a comorbidity index score of 1. Roughly one quarter of patients were bothered by their tumor frequently (22%).

Tumor recurrence was uncommon both in the overall study population and among patients with limited life expectancy at 5 years (3.7% for both). Among limited life expectancy patients with tumor recurrence, 9 of 14 died within a median time of 21 months after recurrence of non-nonmelanoma skin cancer causes.

Patients who were not of limited life expectancy had better 5-year mortality than those of limited life expectancy (11% versus 43.3%, P<0.001). Overall 10-year mortality was 49.9%, but was significantly higher among those with limited life expectancy (76.8% versus 32.7%, P<0.001).

No patients in the study died of nonmelanoma skin cancer-related causes. Leading causes of death in the study population included ischemic heart disease and myocardial infarction, cerebrovascular disease, lung cancer, pneumonia and chronic respiratory diseases, prostate cancer, and Alzheimer’s disease.

Most patients’ tumors were treated surgically, either with excision (34.5%) or chemosurgery (34.2%). Roughly a quarter (26.7%) of patients’ tumors were destroyed through cryotherapy, electrodessication and curettage, laser, or irradiation. Only 3.1% of patients received no treatment. Rates of treatment did not differ significantly between limited life expectancy and nonlimited life expectancy groups.

In a subsample of patients who responded to a questionnaire about treatment-related complications (671 patients, including 212 with limited life expectancy), 30% reported a complication after treatment. Of those reporting complications, 32% were of limited life expectancy.

Common complications included poor wound healing, numbness, itching, and pain.

Finally, treatment patterns did differ between the two study sites, with more surgery (chemosurgery plus excision) performed at the VA center compared with the private clinic (multivariable adjusted relative risk 0.87, 95% CI 0.77 to 1.00, P=0.04).

The authors noted that although symptomatic or medically nonmelanoma skin cancer tumors should be treated regardless of a patient’s life expectancy, asymptomatic tumors “may not be indicated,” and treatment should be considered for benefits, risks, and patient preference.

In an accompanying editorial, Neil Wenger, MD, MPH, of the University of California Los Angeles, seconded the emphasis for shared decision making, particularly in limited life expectancy patients who may not be at increased risk of mortality from disease and who may have quality of life affected by invasive treatment.

“The findings suggest that we are training a new generation of physicians who will inadequately regard the importance of open, honest, patient-oriented communication that strives to facilitate optimal clinical decisions,” he wrote.

The authors noted that the major study limitation was an observational design. The study was also limited by potential lack of generalizability because half of the cohort were veterans


Temporary removal previous post



Hi All
Please be aware this article previous referenced in the blog had been temporarily suspended until further investigation of the validity of the results.
J Plast Reconstr Aesthet Surg. 2013 Mar 13. pii: S1748-6815(13)00069-7. doi: 10.1016/j.bjps.2013.02.002. [Epub ahead of print]

TEMPORARY REMOVAL: Post-procedural pain with photodynamic therapy is more severe than skin surgery: Prospective data.


Department of Cutaneous Oncology, Australasian College of Cutaneous Oncology (ACCO), 66 Roslyn Rd., Belmont, Victoria 3216, Australia. Electronic address:


The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at

Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

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Naturally occurring substance proves effective against deadly skin cancer in laboratory tests

Another substance to add to the list




Naturally occurring substance proves effective against deadly skin cancer in laboratory tests April 10, 2013 in Cancer For the first time, scientists have demonstrated the mechanism of action of gossypin, a naturally-occurring substance found in fruits and vegetables, as a treatment for melanoma, which causes the majority of deaths from skin cancer  ”We identified gossypin as a novel agent with dual inhibitory activity towards two common mutations that are the ideal targets for melanoma treatment,” said Texas Biomed’s Hareesh Nair, Ph.D. At the moment, there is no single therapeutic agent or combination regimen available to treat all melanomas, of which about 76,000 new cases are diagnosed annually, according to the American Cancer Society. “Our results indicate that gossypin may have great therapeutic potential as a dual inhibitor of mutations called BRAFV600E kinase and CDK4, which occur in the vast majority of melanoma patients. They open a new avenue for the generation of a novel class of compounds for the treatment of melanoma,” Nair added. His report, appearing in the March 29, 2013 issue of the journal Molecular Cancer Therapeutics, was funded by the Texas Biomedical Forum and the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation. Nair and his colleagues found that gossypin inhibited human melanoma cell proliferation, in vitro, in melanoma cell lines that harbor the two mutations. Gossypin stunted activities of the mutated genes, possibly through direct binding with them. It also inhibited the growth of various human melanoma cells. In addition, gossypin treatment for 10 days of human melanoma cell tumors with the mutations transplanted into mice reduced tumor volume and increased survival rate. Further studies are planned by Nair’s team to understand how the body absorbs gossypin and how it is metabolized. This idea has been discussed with the Cancer Therapy & Research Center at the UT Health Science Center San Antonio’s Deva Mahalingam, M.D, Ph.D., who is interested in testing gossypin in melanoma patients. Journal reference: Molecular Cancer Therapeutic

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Many skin cancer survivors ignore sun safety advice

A lot of news out today about this

Wear your sunscreen, seek the shade, wear protective clothing and never, ever go to a tanning salon. Despite decades of repetition, many of us fail to follow that skin-saving advice — and a new study shows that’s true even for people who have had the most serious form of skin cancer.

More than a quarter of people who have had melanoma say they never use sunscreen, according to the study presented at a medical meeting Monday. Even greater numbers eschew hats and long sleeves, and 2% admit they have used a tanning bed in the last year, say researchers from Yale University, who presented the data at the annual meeting of the American Association for Cancer Research in Washington, D.C.

Cancer survivors are a bit more careful than the rest of us: 32% always wear sunscreen, while just 17% of other adults do. Overall, they also are more likely to wear hats and long sleeves and stay in the shade. But when compared with others with the same age, race and insurance coverage, the differences are only significant when it comes to sunscreen use, says researcher Anees Chagpar. In other words, a 40-year-old white person with insurance coverage who has been through cancer treatment is just as likely to use a tanning bed or go outside without a wide-brimmed hat as one who has not.

Chagpar, a cancer surgeon, says she finds the data on indoor tanning especially “shocking and concerning.” She says the findings raise questions about whether some people might be “addicted” to tanning.
The study of nearly 27,000 people included 171 who said they had a history of melanoma, which, like other skin cancers, is linked to sun exposure and indoor tanning. It is most common in people with fair skin and a history of sunburns, and it can run in families. It will kill about 9,000 people in the USA this year, according to the non-profit Skin Cancer Foundation.

Survivors are nine times more likely than other people to have melanoma in the future, so experts advise them to take their skin protection seriously.

Several previous studies have suggested such vigilance is hard to maintain, though some studies do find better compliance than the latest survey does, says Mary Tripp, a behavior researcher at the University of Texas MD Anderson Cancer Center in Houston. A possible weakness of the new survey, which has not yet been published, is that it relies on self-reported medical histories, which are sometimes inaccurate, she says.
But she says she has interviewed melanoma survivors who have let down their guard.

“When someone is first diagnosed, they are practicing sun protection, but as the years go by, maybe they tend to fall back on their old habits,” she says. “A lot of melanoma survivors have told me that it is very important for them to maintain a normal outdoor lifestyle.”

Dermatologists don’t want melanoma survivors or the rest of us to stay indoors all the time, says Ali Hendi a dermatologist in Chevy Chase, Md., and a spokesperson for the Skin Cancer Foundation.
Anyone who wants to garden, golf or walk outside should do it, but “be smart about it,” he says, by staying out of the midday sun and using shade, sunscreen and protective clothing.

“You can’t change your genetic makeup, you can’t change the kind of skin you have and you can’t change previous sunburns,” but you can lower your risk, even if you have already had skin cancer, he says.
Still, those who don’t follow that advice have plenty of company, Hendi says: “There are smokers who still continue to smoke after being diagnosed with lung cancer. There are a lot of people in our society who do things they know are not good for them.”

Addiction and denial can play roles in such behaviors, but a lack of complete information may, too, Chagpar says. She says doctors and health educators may need to do a better job of telling people how and why to protect themselves.


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Summary of April JAAD articles

Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border

Thomas L. Hocker, MD,a Ali Alikhan, MD,a Nneka I. Comfere, MD,a,b and Margot S. Peters, MDa,b

Rochester, Minnesota

See related letters on pages 682 and 683

Background: Patients with multiple clinically dysplastic nevi are at increased risk for development of melanoma. However, the risk of melanoma arising in a histologically dysplastic nevus (HDN) is unknown.

Objective: We sought to determine the rate of melanoma development in patients with HDNs that approached a microscopic border but were not re-excised.

Methods: We performed a retrospective study of patients evaluated in our dermatology department from January 1, 1980, to December 31, 1989, who had a HDN that extended to within 0.2 mm of a microscopic punch, shave, or excision border and was not re-excised.

Results: The average follow-up in our cohort of 115 patients was 17.4 years (range: 0.0-29.9): 82 patients (71.3%) were followed up for longer than 10 years, 78 (67.8%) longer than 15 years, and 73 (63.4%) had more than 20 years of follow-up; 66 of 115 nevi were mildly dysplastic, 42 moderately dysplastic, and 7 had severe dysplasia. No patient developed metastatic melanoma or melanoma at the site of removal of a HDN.

Limitations: This was a retrospective study performed at 1 large academic medical center.

Conclusion: During a long-term follow-up period, no patient developed melanoma at the site of an incompletely or narrowly removed HDN, providing evidence that routine re-excision of mildly or moderately dysplastic nevi may not be necessary. ( J Am Acad Dermatol 2013;68:545-51.)



Negative pigment network: An additional dermoscopic feature for the diagnosis of melanoma

Maria A. Pizzichetta, MD,a Renato Talamini, ScD,a Ash A. Marghoob, MD,b H. Peter Soyer, MD,c Giuseppe Argenziano, MD,d Riccardo Bono, MD,e M. Teresa Corradin, MD,f Vincenzo De Giorgi, MD,g Marian A. Gonzalez, MD,h Isabel Kolm, MD,I Andrew W. Kopf, MD,j Joseph Malvehy, MD,k Niccolo Nami, MD,  Margaret Oliviero, MD,I Giovanni Pellacani, MD,m Susana Puig, MD,k Harold Rabinovitz, MD,I Pietro Rubegni, MD,l Stefania Seidenari, MD,m Ignazio Stanganelli, MD,n Andrea Veronesi, MD,a Iris Zalaudek, MD,o Pierfrancesco Zampieri, MD,h and Scott W. Menzies, MB, BS, PhDp Aviano, Reggio Emilia, Rome, Pordenone, Florence, Merano, Siena, Modena, and Meldola, Italy; New  York, New York; Miami, Florida; Barcelona, Spain; Graz, Austria; and Brisbane and Sydney, Australia

Background: The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure.

Objectives: We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions.

Methods: Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN.

Results: The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%),melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas.

Limitations: Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions.

Conclusions: The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric  pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.

( J Am Acad Dermatol 2013;68:552-9.)



Nodular melanoma: A distinct clinical entity and the largest contributor to melanoma deaths in Victoria, Australia

Victoria Mar, MBBS, FACD,a,b,c Hugh Roberts, MBBS, FACD,a Rory Wolfe, BSc, PhD,a,b Dallas R. English, BSc, PhD,d,e and John W. Kelly, MBBS, FACD, MDa Melbourne, Australia

Background: There is a growing body of evidence that nodular melanoma (NM), because of its association with increased growth rate and thickness at diagnosis, accounts for a substantial proportion of melanoma deaths.

Objective: We sought to assess the contribution of NM to melanoma deaths in comparison with other tumor subtypes.

Methods: Four cohorts were established comprising 5775 cases of invasive primary cutaneous melanoma reported to the Victorian Cancer Registry during 1989, 1994, 1999, and 2004. Original pathology reports were reviewed. Age-standardized melanoma incidence rates were compared from 1989 to 2004 with annual percentage change using Poisson regression.

Results: The incidence of thick tumors ([4 mm) increased by 3.8% (95% confidence interval 1.4 to 6.2) and 2.5% (95% confidence interval 0.5 to 5.5) per year for male and female patients, respectively. The median thickness of NM at diagnosis was 2.6 mm compared with 0.6 mm for superficial spreading melanoma. A third of patients who died from melanoma during the follow-up period had thick tumors ([4 mm), most of which were nodular subtype (61%). NM accounted for 14% of invasive melanomas, but was responsible for 43% of melanoma deaths in a total of 57,461 person-years of follow-up. By comparison, superficial spreading melanoma contributed 56% of invasive melanoma but only 30% of deaths.

Limitations: Pathology review was limited to reports only. Mortality information relied mostly on death certificate information.

Conclusion: The incidence of thick melanomas continues to increase. Nodular melanoma is clinically distinct and the predominant contributor to melanoma-related deaths, representing a public health challenge in reducing skin cancer mortality. ( J Am Acad Dermatol 2013;68:568-75.)

Key words: histologic type; melanoma; melanoma deaths; melanoma incidence; melanoma survival; nodular melanoma; tumor subtype.



Pigmented solar (actinic) keratosis: An underrecognized collision lesion

Hye Jin Chung, MD,a Kelly L. McGuigan, MD,b Katie L. Osley, MD,a Kate Zendell, MD,a and Jason B. Lee, MDa Philadelphia, Pennsylvania, and Annapolis, Maryland

Background: The lack of well-established diagnostic criteria for pigmented solar (actinic) keratosis (PSK) along with its poorly understood etiopathogenesis has contributed to underrecognition.

Objective: The clinical, dermatoscopic, and histopathologic features of PSK and the cause of the pigmentation are elucidated.

Methods: In all, 167 histologic specimens, 22 clinical images, and 17 dermatoscopic images of PSK were reviewed. In 38 cases, Melan-A stained sections were available for analysis.

Results: The majority of the lesions were located on the head and neck (84%). A separate pigmented lesion was adjacent to or admixed within PSK in 138 (83%) of the cases indicating that PSK represents a collision between a nonpigmented solar keratosis and a pigmented lesion. Solar lentigo (72%) was the most commonly associated pigmented lesion followed by seborrheic keratosis and melanoma. PSK was suspected clinically in 17% of the cases. There were no significant differences in the quality and quantity of the melanocytes between pigmented and nonpigmented solar keratosis.

Limitations: This was a single-center retrospective study. The sample sizes were small for the clinical and dermatoscopic images and Melan-A stains.

Conclusion: In the majority of the cases, a collision between a nonpigmented solar keratosis and a separate coexistent pigmented lesion, primarily a solar lentigo, accounts for the pigmentation in PSK rather than from any fundamental changes in the quantity or quality of the melanocytes. The collision phenomenon accounts for the spectrum of the clinical and dermatoscopic features observed in PSK and its underrecognition. ( J Am Acad Dermatol 2013;68:647-53.)

Key words: collision tumor; Melan-A; melanoma; pig


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