Posts Tagged ‘skin cancer’

Skin Cancer Explodes

Tuesday, December 21st, 2010

3,5000,000! That is 3,500,000 new cases of skin cancer in the US in 2011.While the numbers are discouraging, the population, especially young people, continue to ignore warnings of unhealthy sun exposure and more importantly dangerous exposure to UVA and UVB radiation in tanning salons. This number also belies 40,000 new cases of malignant melanoma and more than 8,000 deaths from skin cancer in 2011.
There are many consequences of the escalation in incidence of skin cancer. Most obvious is the injury to the skin and subsequent necessity for surgery. Another is the huge cost incurred for diagnosing and treating skin cancer. Lastly there are the cottage industries which have arisen from inappropriate fears of the public. Many physicians have found a lucrative income in performing biopsies and removal of lesions that are not and have little chance of being malignant. Another, or the same? set of physicians make a handsome living removing lesions they “suspect” may become malignant in patients who have already had skin cancer. Many patients return to their physicians month after month and year after year for needless procedures and the track records of these physicians is somewhere between elected officials and the prognostic accuracy of weathermen. The cosmeceutical industry has reaped huge rewards for promoting herbs, vitamins, and proteins for the prevention of skin cancer. None of them, except for vitamin A, have demonstrated conclusive evidence of efficacy.
It is easy for me to become discouraged when I review the indifference of the public to this dynamic problem and the readiness for the medical and cosmeceutical industry to exploit it for profit. I remember the parable of the cave in Plato’s Republic. Plato tells us of a civilization of men and women living in a cave and chained to its walls. Each day light entered the cave from the outside and was reflected down the cave by a series of mirrors so that the perception of reality that the people experienced was a literal reflection of time and light, and not the real thing. Ultimately one of the inhabitants broke free and wandered through the cave to the outside where he saw the sun actually rise and set and observed the subterfuge that had been foisted upon the cave’s inhabitants. Breathlessly he hurried back through the cave to tell his people of the reality that awaited them in the outside world. As he told his story the inhabitants overwhelmed him; chained him again to the wall; and, ignoring his advice continued on with their labors as if nothing had happened.
And then I remembered the campaign against smoking which we have waged over the past 50 years. I remember when people argued over whether cigarette smoke could cause lung cancer. I remember the Marlboro man with his version of macho and his appeal to my generation. And I remember the cost to individuals and to society as we battled what was then the number one cancer and cancer killer. Yet today, smoking in the United States is less frequent; many cities and states ban smoking in public places and restaurants; and no one debates the health hazards of smoking.
Therefore I will once again reiterate that the World Health Organizaiton has found sun tan parlors to be the single biggest cause for the increase in malignant melanoma and skin cancer death. Also, people who have had skin cancer can prevent new cancers with judicious use of topical vitamin A and systemic administration of vitamin A analogues. Lasers combined with photosensitizing chemicals can treat some skin cancers and prevent many others; and neoadjuvant therapy in the form of application of topical chemotherapeutic agents can prevent others. Lastly, there is no proven benefit to constantly destroying lesions that might become cancerous. At the very least patients can request a second opinion before undergoing repeated procedures. And at a bare minimum, all patients should obtain a copy of their records and even more important, read and retain a copy of all pathology reports from removal of lesions of their skin.
Your physician is not the repository of responsibility of your skin health. Like it or not, the buck stops with each of us. 

John Wayne Fights Skin Cancer

Wednesday, August 25th, 2010

Whoah!. Little Lady …(inflection as spoken by John Wayne to Janet Leigh).
Did you see them figures on the rise of skin cancer in the latest publication of The Skin Cancer Foundation? Between 1994 and 2009 the number of yearly skin cancer cases in the US has risen from 1 million cases per year to 2 million cases per year. Malignant melanoma now kills 8600 Americans per year – up from 8000. Indoor tanners have 4.44 times the risk of malignant melanoma as non-tanners (confirmed by the World Health Organization). Window glass filters UVB radiation but allows more than 60% of UVA to penetrate. So much for the ridiculous protests of the tanning industry . The federal government now taxes tanning parlors but classifies the tanning booth as a Class I medical device. Elastic bandages and tongue depressors are also Class I medical devices and I never heard anyone imply that they cause cancer and death.
Now I am not going to get smokers to stop smoking, alcoholics to stop drinking, and tanning addicts to stop tanning. But what about your kids! In Australia every child born will have at least one skin cancer in his lifetime. Right now the odds are something like 1 in 7 children born in the US will have skin cancer at least once in his lifetime and we will achieve Australian status soon. It seems to me that this epidemic will only be controlled by educating young people on the risks and rewards of sun exposure. Yes sunlight is essential for mental well being. Yes, it is an important factor in producing Vitamin D. Yes, I thank God every morning I step out of the house and the sun is shining (I am serious). But enjoying the gifts of Earth does not imply endorsing self-abuse. I see no value in cutting off skin cancer after skin cancer as if that is good medicine although it provides a great living for dermatologists and plastic surgeons.
So here are some ideas:
1. Talk to your kids and grandkids about the need to avoid too much sun and especially sunburns
2. For children under the age of 2 use protective clothing and umbrellas and do not smother them in sun screens which can penetrate their young skin and go into which organ???
3. Sun screens are screens. They let UV light through!! They must be applied every two hours to be effective and they must form a reservoir in the skin to be effective.
4. Do not use combination sunscreens and insecticides. They usually don’t work and they may be harmful.
5. If you have had skin cancer you have 100% chance of another cancer if you live long enough
6. Get on the adjuvant band-wagon. Ask your doctor to help you prevent skin cancer.
7. Take oral vitamin A 10,000-20,000 units daily and get a blood test once a year to make sure you don’t overdose.
8. Apply tretinoin (vitamin A) to your face every night for the rest of your life. Topical and oral vitamin A may provide up to 98% protection from new skin cancer.
9. If a lesion suddenly appears or changes in size, shape, color, or bleeds, see a dermatologist.
10. Don’t give double messages to your kids! If you take care of yourself they may take care of themselves. If they don’t get the message have the kids see me. Sometimes the message gets clearer when presented by someone outside the family- or by an uncle.

If you are or will be a skin cancer patient: read this

Tuesday, March 2nd, 2010

Neoadjuvant Therapy. Adjuvant Therapy. Learn these words. One or the other may save your life if you get cancer. I am largely alive today because I was one of the first participants in a clinical trial using neoadjuvant therapy to treat my pancreatic cancer in 2002. I will write more about that later.
Neoadjuvant therapy can refer to treatments given to reduce tumor size or improve survival before definitive therapy such as surgery is performed. Adjuvant therapy is the use of drugs or other modalities after surgery to reduce the chance of surviving cancer cells from growing.
Skin cancer is the most prevalent cancer in the world. More than 1 million cases occur every year in the United States. It is the 7th leading cause of cancer death in the United States. It is the biggest single drain on the health care system of all cancers. It is promoted by sunlight and directly caused by suntan parlors. The odds of a patient who has had skin cancer developing another skin cancer is 30% over the next 3 years and 100% over a lifetime.
A patient came to see me today who told me about her husband who had skin cancer and a lot of sun exposure in his earlier life. He sees a dermatologist many times a year and at each visit the dermatologist “zaps” off lesions from his face. Yet no matter how many lesions are removed, at the next visit new ones have arisen. I think even a mule understands that when he is overheating in the sun and does not feel well, moving into shade gives relief. Yet here are millions of patients who go month after month, year after year, to get spots “zapped” with the “understanding” that this might prevent skin cancer. At best this is specious reasoning and between the doctor and the patient I am not sure who benefits most.
It was refreshing at the Orlando Dermatology Meeting last December to hear lectures on neoadjuvant and adjuvant therapy to prevent the onset of new lesions and ultimately to prevent new cancers. Remember these names- adjuvant and neoadjuvant. They are available for you now and will be the primary therapy for your children. The fact is patients have options on how to prevent cancer and what follows is a short list to consider:
• Topical vitamin A or tretinoin. Available as a gel or cream a little dab each night may prevent up to 90% of new cancers from arising. This has been known since 1980, yet few physicians recommend it to patients. Coincidentally it is used to treat wrinkles.
• 5-FU (5-fluorouracil): a known anticancer drug for breast and colon, it has been used for years as a cream to treat precancerous lesions. New evidence suggests using it for one week out of the year may prevent even these precancerous lesions from forming.
• PDT (photodynamic therapy): consists of applying a chemical, aminolevulinic acid, to the skin followed by intense light or laser therapy. With more than 20 years experience in Europe it is very successful in treating precancerous lesions and small cancers and is a very popular skin rejuvenation treatment. Like vitamin A you get two for the price of one: better health and better looks.
• Fractional Laser Resurfacing: While not yet successful as a preventive, this is another 1-2 punch making you look better and removing precancerous lesions.
In the 21st century it is archaic to get lesions “zapped” and do nothing to prevent skin cancer and its precancerous growths. In an age where we look to legislation to reduce health care expenditures it is incumbent upon each of us to utilize preventive measures to treat and prevent skin cancer. Well, the time is here and the methods are available. Are you?