What Can Be Done About Sundamaged Skin?

MedicalResearch.com Interview with:

Dr. Janet Prystowsky, MD Dr. Prystowsky is a leading board-certified dermatologist in New York City.  In addition to her private practice, Dr. Prystowsky is a senior attending physician at Mount Sinai Roosevelt/St. Luke’s Medical Center.

Dr. Prystowsky

Dr. Janet Prystowsky, MD
Dr. Prystowsky is a leading board-certified dermatologist in
New York City.  

In addition to her private practice, Dr. Prystowsky is a senior attending physician at Mount Sinai Roosevelt/St. Luke’s Medical Center.
http://www.janetprystowskymd.com/

MedicalResearch.com: When does sun damage to the skin start?  Is there such a thing as a ‘safe tan’?  Who is most susceptible to photoaging?  What parts of the body are more likely to show signs of sun damage? 

Response: Sun damage will increase a person’s risk of premature aging and skin cancer.  Although tanning does function to help protect your skin from excessive ultraviolet radiation tanning is still a form of sun damage.  Also, people with very fair skin may not tan at all; only burn.  They are the most susceptible to sun damage. Certain medical conditions (e.g., Lupus), medications, cosmetics, and food can make your more reactive (photosensitive) to sunlight.

"Sunburn" by Kelly Sue DeConnick is licensed under CC BY-SA 2.0Sunburns are caused by UV damage from sun rays, almost entirely due to UVB rays. UVA rays are weaker for burning but can contribute to blistering sunburns as well. For example, If you get lime peel rubbed on your skin while you are in the sun, you could get a bad burn.  UVA can also cause significant skin damage that can result in premature wrinkling, brown spots, and skin cancer. That’s why you’ll see dermatologists pushing for broad-spectrum sunscreens as opposed to sunscreens that just protect against UVB rays.  Continue reading

Medicare Spends Hundreds of Millions Annually to Treat Precancerous Skin Lesions

MedicalResearch.com Interview with:
“Actinic Keratosis” by Ed Uthman is licensed under CC BY 2.0Howa Yeung, MD
Assistant Professor of Dermatology
Emory University School of Medicine
Atlanta, GA 30322 

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by actinic keratoses?

Response: Actinic keratoses are common precancerous skin lesions caused by sun exposure. Because actinic keratoses may develop into skin cancers such as squamous cell carcinoma and basal cell carcinoma, they are often treated by various destructive methods. We used Medicare Part B billing claims to estimate the number and cost of treated actinic keratoses from 2007 to 2015.

MedicalResearch.com: What are the main findings? 

Response: While the number of Medicare Part B beneficiaries increased only moderately, the number of actinic keratoses treated by destruction rose from 29.7 million in 2007 to 35.6 million in 2015. Medicare paid an average annual amount of $413.1 million for actinic keratosis destruction from 2007 to 2015. Independently billing non-physician clinicians, including advanced practice registered nurses and physician assistants, are treating an increasing proportion of actinic keratosis, peaking at 13.5% in 2015.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should understand that the burden of actinic keratosis treatment is increasing in the Medicare population. There is also an increasing proportion of actinic keratoses being treated by advanced practice registered nurses and physician assistants.  Continue reading

Can the HPV Vaccine Be Used To Treat Some Skin Cancers?

MedicalResearch.com Interview with:

Jeffrey Rapaport

Dr. Rapaport

Dr. Jeffrey Rapaport MD, PA
Emeritus head of Dermatology
Teaneck’s Holy Name Hospital.

Dr. Rapaport discusess a case recently reported in JAMA: In 2016:

A 97-year-old female patient was suffering from multiple squamous cell carcinomas varying from small to incredibly large in size on both of her legs. She was injected with the HPV vaccine commonly known as Gardasil, which is also used to treat warts and oral papilloma. She was first injected in her arm, and then after a period of six weeks, the vaccine was directly injected into her tumors. It was observed that this treatment eventually killed off almost all the tumors on her legs. According to recent press coverage, she is now looking forward to celebrating her 100th birthday in fall 2018.

MedicalResearch.com: What is the background for this study?Is HPV thought be a trigger for some cutaneous squamous cell carcinomas?

Response: The link between skin cancers and HPV vaccinations has normally been investigated in patients who have received organ transplants. Due to the immune-suppressant drugs these patients must take, it is incredibly common to find cases of skin cancer in patients who have undergone transplants. The relaxed immune system, which would normally eliminate cancers caused by the HPV virus, would open the floodgates for multiple skin tumors to emerge. In this case of the 97 year old, I would assume her immune system was healthy. There is, however, growing evidence that receiving multiple vaccines for the HPV virus is necessary even in patients with healthy immune systems. So, regardless of immune health, I believe we need to expand the frequency of the HPV vaccine, even beyond the current three-tiered system for women below 26 and men below 21.

Continue reading

Patients with CLL Should Be Monitored for Skin Cancer, Including Melanoma

MedicalResearch.com Interview with:

Clive S. Zent MD Professor of Medicine Director of Lymphoma/CLL Program Wilmot Cancer Institute University of Rochester Medical Center Rochester NY

Dr. Zent


Clive S. Zent MD

Professor of Medicine
Director of Lymphoma/CLL Program
Wilmot Cancer Institute
University of Rochester Medical Center
Rochester NY

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) have an increased risk of all skin cancers including malignant melanoma.

This study in a stable population of CLL patients managed by a regional referral center confirmed that melanoma was over 6 times more common in than in an age and sexed matched general population. Because of the proactive skin screening program at the University of Rochester Medical Center’s Wilmot Cancer Center, most melanomas (77%) were detected at earlier stages and were treated surgically with curative intent. One patient with CLL and metastatic melanoma had a sustained remission of both diseases on treatment with ibrutinib and pembrolizumab. Continue reading

Waiting Room App Uses Selfies To Show Patients Effects of Sun Damage

MedicalResearch.com Interview with:
Startup Screen Dermatology APPDr. med. Titus Brinker
Head of App-Development // Clinician Scientist
Department of Translational Oncology
National Center for Tumor Diseases (NCT)
Department of Dermatology
University Hospital Heidelberg
Heidelberg

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: ​While everyone in the dermatologic community appears to agree on the importance of UV-protection for skin cancer prevention, busy clinicians often lack time to address it with their patients.

Thus, the aim of this study was to make use of waiting rooms that almost every patient visiting a clinic spends time in and address this topic in this setting by the means of modern technology rather than clinicians time.

We used our free photoaging app “Sunface” which shows the consequences of bad UV protection vs. good UV protection on the users’ own 3D-animated selfie 5 to 25 years in the future and installed it on an iPad. The iPad was then centrally placed into the waiting room of our outpatient clinic on a table and had the Sunface App running permanently. The mirroring of the screen lead to a setting where every patient in the waiting room would see and eventually react to the selfie taken by one individual patient which was altered by the Sunface App.

Thus, the intervention was able to reach a large proportion of patients visiting our clinic: 165 (60.7%) of the 272 patients visiting our waiting room in the seven days the intervention was implemented either tried it themselves (119/72,12%) or watched another patient try the app (46/27,9%) even though our outpatient clinic is well organized and patients have to wait less than 20 minutes on average. Longer waiting times should yield more exposure to the intervention. Of the 119 patients who tried the app, 105 (88.2%) indicated that the intervention motivated them to increase their sun protection (74 of 83 men [89.2%]; 31 of 34 women [91.2%]) and to avoid indoor tanning beds (73 men [87.9%]; 31 women [91.2%]) and that the intervention was perceived as fun (83 men [98.8%]; 34 women [97.1%]).

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Sunscreen Use During Childhood Reduces Melanoma Risk

MedicalResearch.com Interview with:
“Sunscreen” by Tom Newby is licensed under CC BY 2.0Dr Caroline Watts  PhD

Post-doctoral Researcher
The University of Sydney.

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The study analysed data collected from nearly 1700 young Australians who participated in the Australian Melanoma Family Study, a population-based case-control-family study that focused on people who had a melanoma under 40 years of age and compared them with people the same age who did not have a melanoma.

We examined sunscreen use during childhood and adulthood and its association with melanoma risk and found that compared to people who did not use sunscreen, regular sunscreen use during childhood reduced melanoma risk by 30-40 per cent.  Continue reading

Gym Tanners More Likely To Show Signs of “Tanning Addiction.”

MedicalResearch.com Interview with:
Sherry Pagoto, PhD
Director, UConn Center for mHealth and Social Media
President, Society of Behavioral Medicine
UConn Institute for Collaboration in Health, Interventions, and Policy
Professor, Department of Allied Health Sciences
University of Connecticut
Storrs, CT 06268

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent research has shown that while physical activity is associated with reduced risk for many cancers, it is associated with an increased risk for melanoma. We are not sure why this is the case, however, we have noticed that popular gym chains (e.g., Planet Fitness) often offer tanning beds, which are carcinogenic.

We surveyed over 600 people who had used a tanning bed at least once in their life to see how many had used tanning beds in gyms. About one-quarter had used tanning beds in gyms and those folks actually tanned significantly more than people who had not tanned in gyms.  Gym tanners were also more likely to show signs of “tanning addiction.”  We also found an association between tanning and physical activity, such that the people who were the most physically active were the heaviest tanners.  Continue reading

Simple Interventional Program Can Reduce Sunburns in Outdoor Workers

MedicalResearch.com Interview with:
“Brad at Santa Monica Pier on Ferris Wheel” by Brad Cerenzia is licensed under CC BY 2.0Sonia Duffy, PhD, RN, FAAN
Professor, College of Nursing
The Ohio State University

MedicalResearch.com: What is the background for this study?

Response: Prior to conducting a tobacco cessation study with Operating Engineers, I conducted a survey of 498 Operating engineer and found that many of them were at risk for sun burning, which can lead to skin cancer.  So as a follow up study, I conducted a study to prevent sun burning, which randomized 357 Operating Engineers to were randomized to four interventions: education only; education and text message reminders; education and mailed sunscreen; and education, text message reminders, and mailed sunscreen.

Continue reading

Shining Sunlight on Sunscreens and Sunburns

MedicalResearch.com Interview with:
Dr. Janet Prystowsky, MD

Dr. Janet Prystowsky, MD Dr. Prystowsky is a leading board-certified dermatologist in New York City.  In addition to her private practice, Dr. Prystowsky is a senior attending physician at Mount Sinai Roosevelt/St. Luke’s Medical Center.

Dr. Prystowsky

Dr. Prystowsky is a leading board-certified dermatologist in
New York City.  

In addition to her private practice, Dr. Prystowsky is a senior attending physician at Mount Sinai Roosevelt/St. Luke’s Medical Center.
http://www.janetprystowskymd.com/

MedicalResearch.com: Are all sunscreens created equally? 

Response: Not all sunscreens are created equally. Always choose a broad-spectrum sunscreen that is water resistant if you are planning outdoor sports (with sweating) or swimming. Water resistance is a must when you are swimming or sweating (and who isn’t sweating on a hot summer day?)

However, you do not need water resistance if you are walking a few blocks in moderate temperatures. In that situation, a moisturizer sunscreen that is not water resistant is OK and may feel more comfortable on your skin.

As far as ingredients go, your best choice is a mineral based sunscreen with zinc oxide and/or titanium dioxide.

Sunscreens that are not broad spectrum may protect you from sunburns but will not protect you from photodamage that can lead to premature aging and skin cancer.

Mineral based sunscreens are preferable over chemical sunscreens because the long-term effects of chemical sunscreens aren’t well understood. What we do know is that chemical sunscreens can absorb into our bloodstream and potentially have hormonally disruptive effects.  Continue reading

Common Diuretic HCTZ Associated With Increase Risk of Skin Cancers

MedicalResearch.com Interview with:

"Hydrochlorothiazide (HCTZ or HCT) is a diuretic medication often used to treat high blood pressure and swelling due to fluid build up" - Wikipedia

“Hydrochlorothiazide (HCTZ or HCT) is a diuretic medication often used to treat high blood pressure and swelling due to fluid build up” – Wikipedia

Sidsel Arnspang Pedersen MD
Department of Public Health, Clinical Pharmacology and Pharmacy
Anton Pottegård PhD
Associate professor, Clinical Pharmacy
Odense University Hospital
University of Southern Denmark,

The following is based on results from three published papers in JAAD and JAMA Internal Medicine. (1–3)

 

MedicalResearch.com: What is the background for this study?

Response: Hydrochlorothiazide is one of the most frequently used diuretic and antihypertensive drugs in the United States and Western Europe. The drug is known to be photosensitizing and has previously been linked to lip cancer.4–6 Based on these previous findings, the International Agency for Research on Cancer (IARC) has classified hydrochlorothiazide as ‘possibly carcinogenic to humans’ (class 2B).

This prompted us to investigate whether use of hydrochlorothiazide was associated to other UV dependent skin cancers, including non-melanoma skin cancer (i.e. basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)), cutaneous melanoma, as well as the more rare non-melanoma skin cancers Merkel cell carcinoma and malignant adnexal skin tumours.

Continue reading

Organ Transplant Recipients Require Vigilant Sun Protection

MedicalResearch.com Interview with:
“Sunscreen” by Tom Newby is licensed under CC BY 2.0Rebecca Ivy Hartman, M.D
Instructor in Dermatology
Brigham and Women’s Hospital
Boston MA 02115

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Organ transplant recipients (OTR) are at 100-fold higher risk to develop certain skin cancers compared to the general population due to immunosuppression, and thus preventing skin cancer in this population is critical.

Our study found that in a high-risk Australian OTR population, only half of patients practiced multiple measures of sun protection regularly.

However, after participating in a research study that required dermatology visits, patients were over 4-times more likely to report using multiple measures of sun protection regularly. Patients were more likely to have a positive behavioral change if they did not already undergo annual skin cancer screening prior to study participation.

Continue reading

New Guidelines Improve Melanoma Diagnosis, But Still Room For Improvement

MedicalResearch.com Interview with:
Joann G. Elmore, MD, MPH
Professor of Medicine
David Geffen School of Medicine at UCLA
Director of the UCLA National Clinician Scholars Program
Affiliate Professor of Medicine, University of Washington School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In a recent study published in 2017 in the British Medical Journal, our team found that pathologists disagreed on their diagnoses of some melanocytic skin biopsy lesions and early stage invasive melanoma more than 50% of the time. This concerning level of disagreement was particularly true for diagnoses in the middle of the disease spectrum, such as atypical lesions and melanoma in situ.  For example, Figure 1 from this paper shows the diagnoses of 36 pathologists who interpreted the same glass slide of a skin biopsy using their own microscopes; the diagnoses ranged from a benign lesion to invasive melanoma.

Since that study, the American Joint Committee on Cancer has released new guidelines for melanoma staging. Given this change, we wanted to examine whether the updated guidelines improved the reliability of melanoma diagnosis.

We found that using the new guidelines improved the accuracy of pathologists’ diagnoses for invasive melanoma (Elmore J, et al, JAMA Network Open 2018).  Continue reading

EWG Urges Sunscreen Companies and Consumers To Go Oxybenzone-Free By 2020

MedicalResearch.com Interview with:
“Sunscreen” by Tom Newby is licensed under CC BY 2.0Carla Burns, M.S.

Environmental Working Group
She is one of the coauthors of the 2018 Guide to Sunscreens. 

MedicalResearch.com: What is the background for the EWG report? 

Response: Environmental Working Group (EWG) published its first Sunscreen Guide in 2007.

When we first started the guide, many sun protection products sold in the U.S. were not as safe and used misleading marketing claims.

Throughout the years, EWG has continued to find that a common sunscreen ingredient, oxybenzone, poses a hazard to human health and the environment. Despite EWG’s efforts to draw attention to the health hazards associated with this ingredient over the last 12, oxybenzone remains widely used in chemical-based sunscreens. So, this year, we are ramping up our efforts to rid the market of this ingredient by launching a campaign to urge companies and consumers to go oxybenzone-free by 2020.

Continue reading

SKINDER App Teaches Intuitive Visual Diagnosis of Melanoma

MedicalResearch.com Interview with:

SKINDER APP

Image from SKINDER APP

Michael SKolodneyMD, PhD
Section of Dermatology, Department of Medicine
West Virginia University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Melanoma is easily curable if recognized early.   Dermatologists are good at spotting melanomas because they develop an innate sense of how melanomas appear after examining thousands of malignant and benign lesions.  In contrast, most medical students are relatively disadvantaged by their limited dermatology exposure. We felt that too little experience, rather than lack of knowledge of the rules, is the primary barrier to development of pattern-recognition and intuition as a reliable tool for melanoma diagnosis in non-experts.  To remedy this problem, we developed a novel web-based application to mimic the training of a dermatologist by teaching medical students intuitive melanoma diagnosis in a highly condensed period of time.

Our application, which we call Skinder, teaches intuitive visual diagnosis of melanoma by quickly presenting the learner with thousands of benign and malignant skin lesions.  The user makes rapid binary decisions, by swiping right for benign or left for malignant, and receives instant feedback on accuracy. With this application, the learner can amass a mental repository of diagnostic experience in a short amount of time. To determine if intuitive visual diagnosis training is superior to a traditional rule-based approach, we compared our web-based application to a rules based approach, the publicly available INFORMED Skin Education Series.

Medical students were tested on the ability top differentiate melanomas from benign pigmented lesions before and after training with either Skinder of the Informed Skin Education Series. The pre-test mean for the Skinder group was 75% correct, compared to 74.7% correct for the INFORMED group. The post-test mean for the skinder application group was 86.3% correct, compared to 77.5% correct for the INFORMED group which was highly signifcant.

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New Focus for Inflammatory Skin Disease and Psoriasis: Topical Glucose Transport Inhibitors

MedicalResearch.com Interview with:

Richard Wang, M.D., Ph.D.  Assistant Professor Dermatology UT Southwestern Medical Center 

Richard Wang, M.D., Ph.D. 
Assistant Professor Dermatology
UT Southwestern Medical Center 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Targeting cellular metabolism is currently being explored as a new way to diagnose and treat diseases. In particular, there has been increasing interest in specifically targeting metabolic pathways are preferentially altered in disease states, like cancer.  Although an increased dependence on glucose transport and metabolism has been well established for rapidly proliferating cells, attempts to target this conserved pathway have been limited by concerns about the high potential for side effects from the systemic inhibition of glucose transport.

To investigate the feasibility of targeting glucose transport in skin diseases, we investigated the effect of inhibiting glucose transport in the skin by deleting the primary glucose transporter in the skin, Glut1, in mouse keratinocytes. We confirmed that the Glut1-deficient keratinocytes showed metabolic and oxidative stress and impaired proliferation. However, the keratinocyte-specific ablation of Glut1 did not compromise mouse skin development and barrier function. Metabolomic profiling revealed sphingolipid, hexose, amino acid, and nucleotide adaptations in Glut1-deficient keratinocytes. However, Glut1 deficient skin did show defects in both proliferation and migration after physiologically relevant stressors like excisional wounds and UV-B irradiation.

Given its importance during stressors, we further tested whether Glut1 was important in the pathogenesis of psoriasis models. Notably, both the genetic and pharmacological inhibition of Glut1 decreased hyperplasia in mouse and human organic models of psoriasis. Moreover, the topical application of a Glut1 inhibitor further decreased inflammation in these models. The ability to deliver glucose transport inhibitors specifically to the skin may limit the adverse effects from the systemic inhibition of glucose transport and suggests that the topical inhibition of glucose transport may be a novel approach to treat hyperproliferative and inflammatory skin diseases.  Continue reading

PAs Do More Biopsies, Find Less Early Melanoma than Dermatologists

MedicalResearch.com Interview with:

Laura Korb Ferris, MD, PhD Associate Professor, University of Pittsburgh Clinical and Translational Science Institute Director of Clinical Trials, Department of Dermatology University of Pittsburgh Medical Center

Dr. Laura K. Ferris

Laura K. Ferris MD, PhD
Associate Professor, University of Pittsburgh Clinical and Translational Science Institute
Director of Clinical Trials, UPMC Department of Dermatology
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Dermatology is one of the greatest utilizers of physician extenders, including physician assistants (PAs) in medicine. The scope of practice of PAs has also expanded over time from a role in assisting the dermatologist to taking a more independent role and many PAs now do skin cancer screening examinations and make independent decisions about which lesions are suspicious for skin cancer and need to be biopsied.

Our main findings were that, overall, in comparison to board-certified dermatologists, PAs were more likely to perform biopsies of benign lesions. For every melanoma that they found, PAs biopsied 39 benign lesions whereas dermatologists biopsied 25.

In addition, PAs were less likely than dermatologists to diagnose melanoma in situ, the earliest and most curable, but also hardest to identify and diagnose, form of melanoma. However, PAs had a similar rate of diagnosing the more clinically-obvious forms of skin cancer, including invasive melanoma, basal cell carcinoma, and squamous cell carcinoma.

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USPSTF: Behavioral Counseling of Children and Teens to Prevent Skin Cancer Recommended

MedicalResearch.com Interview with:

John W. Epling, Jr., M.D.

Dr. Epling

John W. Epling, Jr., M.D., M.S.Ed., Task Force Member
Dr. Epling is is a professor of Family and Community Medicine at the Virginia Tech Carilion School of Medicine in Roanoke, VA. He is also the Medical Director of Research for Family and Community Medicine, Medical Director of Employee Health and Wellness for the Carilion Clinic, and maintains an active clinical primary care practice. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Skin cancer is the most common type of cancer in the U.S., affecting millions of people every year. The Task Force looked at the latest research to see if clinicians can help people prevent skin cancer by providing counseling about ways to reduce risk, including using sunscreen, wearing protective clothing, and avoiding sunlight during peak hours.

Sunburn damaged skin - wiki image

Sunburn damage – wiki image

Based on our review of the evidence, we found that counseling younger patients with a fair skin type and their parents is effective at encouraging these sun protective behaviors. By helping reduce their patients’ exposure to harmful UV rays, clinicians can decrease their risk for skin cancer. As such, we recommend that clinicians provide counseling to people who are six months to 24 years old and have a fair skin type. For adults over 24 with a fair skin type, clinicians should consider the individual’s risks for skin cancer when deciding whether or not to provide counseling.  Continue reading

Study Finds Adults Who Used Sunscreen Slightly More Likely To Get Sunburned

MedicalResearch.com Interview with:
“Sunburn” by Beatrice Murch is licensed under CC BY 2.0Dawn Holman, MPH
Behavioral Scientist Division of Cancer Prevention and Control
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sunburn at any age increases a person’s chances of developing skin cancer in the future. Using a combination of strategies including staying in the shade, wearing clothing that covers the arms and legs, wearing a hat with a wide brim, and wearing sunscreen (SPF 15+) on exposed skin can protect skin from sun damage and reduce risk of sunburn.

This study used national data to examine how often US adults used these sun protection strategies when outdoors in the sun for an hour or longer and how many US adults got sunburned in 2015.

Among adult women, staying in the shade and using sunscreen were the most common sun protection methods. About 40% of women regularly used these strategies. Women were less likely to wear a wide-brimmed hat (14%) or wear clothing covering their arms (11%) and legs (23%).

Among adult men, wearing pants or other clothing covering their legs and staying in the shade were the most common sun protection methods. Just over 30% of men regularly used these strategies. Men were less likely to use sunscreen (22%), wear a wide-brimmed hat (14%) or wear a shirt with long sleeves (13%).

About one-third of US adults got sunburned in 2015. Sunburn was even more common among certain groups. For example, about half of individuals with sun-sensitive skin and about half of adults aged 18-29 got sunburned.

Certain behaviors and health conditions were related to sunburn. For example, adults who used sunless tanning products to darken their skin, binge drank, engaged in aerobic activity, or were overweight or obese were more likely to get sunburned compared to other adults. Adults who regularly stayed in the shade when outdoors or avoided long periods of time in the sun were slightly less likely to get sunburned compared to other adults.

Adults who regularly used sunscreen were slightly more likely to get sunburned. Continue reading

Potentially Cancerous Genital Lesions Common in Transplant Population

MedicalResearch.com Interview with:

Dr. Christina Lee Chung, MD Associate Professor Department of Dermatology Drexel University

Dr. Chung

Dr. Christina Lee Chung, MD
Associate Professor
Department of Dermatology
Drexel University

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: In early 2016, five years after the inception of our specialty medical-surgical transplant dermatology center, we realized our nonwhite transplant patients were developing skin cancer at higher rates and found interesting trends. These data were published in a previous manuscript. One of the more striking findings was that these patients were developing a high proportion of skin cancer in non-sun-exposed areas such as the genital region. There are no standard guidelines regarding genital skin evaluation and it is unclear how often it is performed in any capacity amongst dermatologists, including practitioners in our center, quite frankly. Our group was concerned that we could be missing skin cancers in this “hidden” area in our high-risk organ transplant population so we launched a quality improvement initiative that incorporated thorough genital skin evaluation as a standard part of post-transplant skin cancer screening.   

Fifteen months after we started this modified screening process, we decided to evaluate the results. To account for any variation in examination, we looked at the findings of a single practitioner.

We found that genital lesions are common in the transplant population and include high rates of genital warts and skin cancer. However, patient awareness of the presence of genital lesions was alarmingly low. Nonwhite transplant patients, Black transplant recipients in particular, were disproportionately affected by both genital warts and genital skin cancer in our cohort. Similar to cervical cancer, high-risk HPV types were closely associated with genital squamous cell carcinoma development in our transplant population. Continue reading

Transplant Network Undercaptures Post-Transplant Skin Cancers

MedicalResearch.com Interview with:

Thuzar M.Shin MD, PhD Assistant Professor of Dermatology Hospital of the University of Pennsylvania

Dr. Shin

Thuzar M.Shin MD, PhD
Assistant Professor of Dermatology
Hospital of the University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Organ Procurement Transplant Network (OPTN) collects data on cancers that develop after organ transplantation. Previous studies have shown incomplete reporting to the OPTN for many cancers (including melanoma). Skin cancer is the most common malignancy in solid organ transplant recipients and the most common post-transplant skin cancer, cutaneous squamous cell carcinoma (cSCC), is not captured in standard cancer registries. We hypothesized that cSCC and melanoma are underreported to the OPTN. When compared to detailed medical record review obtained from the Transplant Skin Cancer Network database (JAMA Dermatol. 2017 Mar 1;153(3):296-303), we found that the sensitivity of reporting to the OPTN was only 41% for cSCC and 22% for melanoma. The specificity (99% for cSCC and 100% for melanoma) and negative predictive values (93% for cSCC and 99% for melanoma) were high. As a result, the OPTN database is unable to robustly and reliably distinguish between organ transplant recipients with and without these two skin malignancies.

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No Detectable Improvement in Photodamaged Skin From Course of Topical 5 Fluorouracil

MedicalResearch.com Interview with:

Kaveri Korgavkar, MD Department of Dermatology Brown University Providence, Rhode Island 

Dr. Korgavkar

Kaveri Korgavkar, MD
Department of Dermatology
Brown University
Providence, Rhode Island 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Photodamage refers to premature skin aging from long-term UV exposure. Topical fluorouracil cream, typically used in the treatment of actinic keratosis, has been suggested for use in treating photodamage due to clinical and histological findings. However, in our ad hoc secondary analysis of a large randomized clinical trial, a standard course of topical fluorouracil did not result in detectable improvement of photodamage.

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Could Nicotinamide Be A Tool In Fight Against Skin Cancer?

MedicalResearch.com Interview with:
Prof. Gary M. Halliday

Discipline of Dermatology, Bosch Institute
Central Clinical School
University of Sydney
Sydney, NSW, Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The recently published article is a review paper- we reviewed previous laboratory studies of the effects of nicotinamide on normal pigment cells and on melanoma, and also the previous studies showing that nicotinamide can reduce rates of non-melanoma skin cancer (basal cell and squamous cell carcinoma) in high risk patients. We have not done any clinical investigations of nicotinamide as a preventive agent for melanoma.

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Iris Freckles Are A Potential Biomarker for Chronic Sun Damage

MedicalResearch.com Interview with:

Iris Freckles Credit: © Africa Studio / Fotolia

Iris Freckles
Credit: © Africa Studio / Fotolia

Dr.med.univ. Christoph Schwab
Departement of Ophthalmology
Medical University of Graz
Graz, Austria 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Knowledge about risk factors and/or pathways involved in pathogenesis is from special importance in order of preventing diseases.

The role of sunlight in several eye diseases is unclear. In our study we found a close relation between sun light exposure – evaluated by a full body skin examination and a personal questionnaire – and iris freckles. Therefore we suggest the presence of iris freckles as a novel biomarker indicating high ocular sun exposure.

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Higher HIV Viral Loads Linked to Increased Squamous Cell Cancers of Skin

MedicalResearch.com Interview with:

Maryam M. Asgari, MD, MPH Department of Dermatology, Massachusetts General Hospital, Department of Population Medicine Harvard Medical School, Boston, Massachusetts Division of Research, Kaiser Permanente Northern California, Oakland

Dr. Asgari

Maryam M. Asgari, MD, MPH
Department of Dermatology
Massachusetts General Hospital,
Department of Population Medicine
Harvard Medical School, Boston, Massachusetts
Division of Research, Kaiser Permanente
Northern California, Oakland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nonmelanoma skin cancer – defined as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) – is a common malignant condition, affecting more than 2 million Americans every year. BCCs are more common than SCCs among individuals with healthy immune systems, while SCCs are more predominate than BCCs among people who are immunocompromised.

We examined how laboratory markers used to evaluate HIV disease progression may be associated with subsequent nonmelanoma skin cancer risk in white patients previously diagnosed with at least one such cancer from 1996 to 2008.  We measured CD4 count, viral load and subsequent nonmelanoma skin cancer. The study included 455 participants with HIV and 1,952 without HIV. All were members of the Kaiser Permanente Northern California health care plan.

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Clinical Perineural Invasion of Cutaneous SCC May Warrant Adjuvant Treatment

MedicalResearch.com Interview with:
Dr. Chrysalyne D. Schmults, MD, MSCE
Associate Professor of Dermatology, Harvard Medical School
Director, Mohs and Dermatologic Surgery Center and
Mr. Pritesh S. Karia, MPH
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Department of Dermatology
Brigham and Women’s Faulkner Hospital
Harvard Medical School, Boston, Massachusetts
Jamaica Plain, MA 02130-3446 

MedicalResearch.com: What is the background for this study?

Response: Perineural nerve invasion (PNI) is a well-recognized risk factor for poor prognosis in patients with cutaneous squamous cell carcinoma (CSCC). Most cases of CSCC with PNI are identified on histologic examination at the time of surgery and the patient has no clinical symptoms or radiologic evidence of PNI. These cases are classified as incidental PNI (IPNI). However, some patients with PNI present with clinical symptoms and/or radiologic evidence of PNI. These cases are classified as clinical PNI (CPNI). A few studies have shown differences in disease-related outcomes between CSCC patients with IPNI and CPNI but consensus regarding adjuvant treatment and detailed guidelines on follow-up schedules have not yet materialized.

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