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The farther a patient has to travel to see the doctor who diagnoses their melanoma, the more likely they are to have thicker -- and more lethal -- skin cancer at the time of diagnosis, a new study warns.
Patient income also makes a difference, with poorer patients getting diagnosed with thicker melanomas, the researchers said.
"Survival for patients with melanoma is dependent on stage at diagnosis. As Breslow (depth of tumor cells in the skin) thickness increases, overall survival decreases," wrote Dr. Karyn B. Stitzenberg, of the School of Public Health at the University of North Carolina at Chapel Hill, and her colleagues.
"Consequently, early diagnosis may substantially improve patient outcomes," the researchers added. But, "because melanoma can only be definitively diagnosed based on biopsy findings, diagnosis requires detection of the suspicious lesion and biopsy. Some primary care providers perform diagnostic biopsies, but many prefer to refer patients to dermatologists or surgeons."
Among the patients in this study, the median distance to a diagnosing physician was eight miles, and the median Breslow thickness was 0.6 millimeters. For each one-mile increase in distance to the doctor, there was a 0.6 percent increase in Breslow thickness, the study found.
Patients who had to travel more than 15 miles to see their doctor had about 20 percent greater Breslow thickness than those who were less than 15 miles away.
Compared to those in metropolitan counties, patients in rural counties traveled an average of 2.4 miles farther to their diagnosing doctor. Patients in counties with at least one dermatologist traveled an average of 8.3 miles less than those in counties without a dermatologist.
The study also found an association between Breslow thickness and age and poverty.
"For each one percent increase in poverty rate, Breslow thickness increased by one percent. Breslow thickness was 19 percent greater for patients aged 51 to 80 years than for those aged 0 to 50 years and was 109 percent greater for patients older than 80 years than for those aged 0 to 50 years," the study authors wrote.
The study is published in the August issue of the journal Archives of Dermatology.
HealthDay News, August 22, 2007
Hispanic-American teens are more likely than their white peers to take risks that boost their odds for skin cancer, a new survey finds.
Reporting in the August issue of the journal Archives of Dermatology, a team at the University of Miami's Miller School of Medicine surveyed 369 high school students (221 white Hispanics and 148 white non-Hispanics).
They found that Hispanic teens were more likely to use tanning beds, less likely to consider themselves at risk for skin cancer, and less likely to protect themselves from the sun.
Compared to white non-Hispanics, white Hispanics were:
- More likely to tan deeply (44.2 percent vs. 31 percent).
- About 1.8 times more likely to never or rarely use sun-protective clothing.
- About twice as likely to never or rarely use sunscreen.
- 2.5 times more likely to have used a tanning bed in the previous year.
- 60 percent less likely to have heard of skin self-examination and 70 percent less likely to have been told how to do it.
- Less likely to think they had an average or above-average risk for skin cancer (23.1 percent vs. 39.9 percent).
There's a real need to improve participation of white Hispanic students in skin cancer prevention programs, the authors concluded.
Exposure to the sun's ultraviolet (UV) rays is a major risk factor for skin cancers, and a person's majority of lifetime UV exposure occurs by age 18, the Miami team noted. White Hispanics have a lower rate of skin cancer than white non-Hispanics, but white Hispanics are more likely to be diagnosed with more advanced skin cancer.
HealthDay News, August 20, 2007
Over the past several decades, the incidence of melanoma – the most serious form of skin cancer – has steadily increased in the United States. From 1995 to 2004, melanoma has increased by more than 1 percent per year in this country – in sharp contrast to overall cancer rates that have steadily decreased by 0.6 percent per year during this time. While dermatologists and other public health officials work together to try to reverse this alarming trend, key findings from a successful multi-faceted intervention program designed to increase sun-safe behavior in children could play an important role in decreasing melanoma in future generations.
Speaking today at the American Academy of Dermatology’s Summer Academy Meeting 2007, dermatologist Martin A. Weinstock, MD, PhD, FAAD, professor of dermatology and community health at Brown University in Providence, R.I., and chief dermatologist at Veterans Affairs Medical Center in Providence, presented a summary of recently published research on the rising incidence of melanoma and trends in sun exposure.
“While the increase in melanoma rates from 1995 to 2004 was not specific to one age group, we did notice an increase in the youngest age group (from ages 15 to 30) and in the age 60 and older age group,” said Dr. Weinstock. “The possible reasons for this increase in younger and older Americans are not documented, but one possible explanation could be more exposure to UV radiation – which we know is the most preventable risk factor for melanoma.”
Youth and Sun Exposure
One population-based study published in the September 2006 issue of the journal Pediatrics found that although there was not a significant change in the proportion of youths that reported getting sunburned from 1998 to 2004, there were some interesting distinctions between the younger and older youths. For example, the 16 - 18 age group had more sunburns during that time period compared to the 11 - 13 and 14 -15 age groups – including an increase in the reported number of sunburns over the six-year study period. In 2004, 70 percent of the 16- to 18-year-olds reported getting sunburned, an increase from 64 percent reported by this age group in 1998.
In contrast, the study found that the younger age groups (ages 11 - 15) reported fewer sunburns and a decrease in the number of sunburns from 1998 to 2004. Specifically, the youngest age group studied (ages 11 - 13) fared the best in terms of the fewest sunburns – dropping from 75 percent in 1998 to
67 percent in 2004. Those in the 14 - 15 age group also reported a decrease in the number of sunburns from 1998 to 2004 – from 79 percent in 1998 to 70 percent in 2004.
“The study did not provide a definitive explanation as to why the younger age groups had fewer sunburns than their older counterparts, but one possible reason is that younger adolescents are more responsive to parental guidance than older teens – who tend to be influenced more by their peers,” explained Dr. Weinstock. “This trend, however, is worth noting in future public education campaigns geared toward teens and adolescents.”
Another study published in the January 2007 issue of the journal Pediatrics found that a multi-component community-based intervention successfully increased sun-protection behaviors in adolescents entering 6th to 8th “SunSafe in the Middle Years” program, designed as a randomized, controlled trial. The intervention used a broad range of role models – including school personnel, coaches, pediatricians, teen peer advocates and lifeguards – who actively encouraged adolescents to practice proper sun protection in different environments.
“The study found that there was significant improvement in the areas of the body protected by sunscreen, clothing or shade in the adolescents in the 10 communities randomly selected for the intervention versus those in the control towns,” said Dr. Weinstock. “From previous research, we know that compliance with sun-protective behaviors goes down between 6th to 8th grades. I think this study demonstrates that a multi-component program which involves a variety of people influential to this age group can have a positive impact on sun protection behavior and should be considered a model for future educational efforts aimed at adolescents.”
Adults and Sun Exposure
Adults also failed to heed the warnings of dermatologists when it comes to practicing proper sun protection. A new article published in the June 1, 2007, issue of the Centers for Disease Control and Prevention’s (CDC’s) Morbidity and Mortality Weekly Report presented data showing an upward trend in the incidence of sunburns in U.S. adults. From 1999 to 2004, there was a 2 percent increase in the number of adults 18 years and older who reported getting sunburned (32 percent to 34 percent, respectively). While this represents only a slight increase, Dr. Weinstock pointed out that the data demonstrates that the occurrence of sunburns in the adult population is not decreasing.
“Dermatologists are concerned that melanoma and other skin cancers will continue to increase as long as sun exposure does,” said Dr. Weinstock. “Since we know that overexposure to UV radiation is the most preventable risk factor for developing skin cancer, it’s critical for dermatologists to emphasize that people should practice proper protection when engaging in outdoor activities.”
The Academy recommends that people of all ages Be Sun SmartTM by following these tips:
- Generously apply sunscreen with a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both ultraviolet A
- (UVA) and ultraviolet B (UVB) rays. Re-apply every two hours, even on cloudy days, and after swimming or sweating. Look for the AAD Seal of Recognition™ on products that meet these criteria.
- Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
- Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m.
- Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
- Protect children from sun exposure by applying sunscreen.
- Get vitamin D safely through a healthy diet that includes vitamin supplements. Don’t seek the sun.
- Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
- Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.
According to current estimates, there will be about 108,230 new cases of melanoma diagnosed in 2007 – 48,290 noninvasive and 59,940 invasive. For more information about skin cancer, visit www.skincarephysicians.com and click on “SkinCancerNet.”
New initiatives by this organization help ensure the credibility of natural products for the consumer.
The U.S. House Committee on Appropriations, late yesterday, approved a $2 million increase for the U.S. Food and Drug Administration’s (FDA) Office of Cosmetics and Colors. Cosmetic, Toiletry, and Fragrance Association (CTFA) President and CEO Pamela Bailey issued the following statement praising the committee’s efforts for an increase that will enhance the office’s capacity for enforcement, oversight and development of global safety standards for personal care products. "We are pleased that the House Committee on Appropriations voted to increase FDA funding for consumer protection. Our products literally touch nearly every American every day. Through strong regulatory oversight, made possible by this $2 million increase, consumer confidence in the safety of their products will remain high. "Consumer safety is the number one priority of the more than 1,000 cosmetic and personal care product companies. Over the years, cosmetic and personal care product companies have worked with FDA to establish a unique partnership in which companies go beyond the requirements of the law to provide additional safety and technical resources and information. "Our strong partnership with FDA has been put at risk because the Office of Cosmetics and Colors has shrunk to an insufficient level. This increase will enhance consumer protections and provide the cosmetics office with much needed inspectors and compliance officers. "Consumers depend on safe products that are available and consistently regulated across the globe. While FDA has long been the gold standard in cosmetics regulation in the U.S., without adequate funding the FDA may not have the resources to participate in meetings with regulatory officials around the world. This funding increase will allow critical FDA participation in international discussions to develop the best and most encompassing global protections and regulations for consumers everywhere."
The U.S. House Committee on Appropriations, late yesterday, approved a $2 million increase for the U.S. Food and Drug Administration’s (FDA) Office of Cosmetics and Colors. Cosmetic, Toiletry, and Fragrance Association (CTFA) President and CEO Pamela Bailey issued the following statement praising the committee’s efforts for an increase that will enhance the office’s capacity for enforcement, oversight and development of global safety standards for personal care products.
"We are pleased that the House Committee on Appropriations voted to increase FDA funding for consumer protection. Our products literally touch nearly every American every day. Through strong regulatory oversight, made possible by this $2 million increase, consumer confidence in the safety of their products will remain high.
"Consumer safety is the number one priority of the more than 1,000 cosmetic and personal care product companies. Over the years, cosmetic and personal care product companies have worked with FDA to establish a unique partnership in which companies go beyond the requirements of the law to provide additional safety and technical resources and information.
"Our strong partnership with FDA has been put at risk because the Office of Cosmetics and Colors has shrunk to an insufficient level. This increase will enhance consumer protections and provide the cosmetics office with much needed inspectors and compliance officers.
"Consumers depend on safe products that are available and consistently regulated across the globe. While FDA has long been the gold standard in cosmetics regulation in the U.S., without adequate funding the FDA may not have the resources to participate in meetings with regulatory officials around the world. This funding increase will allow critical FDA participation in international discussions to develop the best and most encompassing global protections and regulations for consumers everywhere."
Staying on top of the newest developments in the field and introducing them to your clients allows you to continually re-establish yourself as their personal skincare expert. With that in mind, you should know that anti-aging isn’t just about wrinkles anymore. Many scientists and dermatologists are confirming that the tone of a person’s skin is among the main identifiers in determining their age—the more even skin tone is, the younger a person looks.
Progress in anti-aging skin care has moved one step further due to the development of a breakthrough topical glucosamine complex. It treats uneven skin tone by targeting skin cells that overproduce melanin. Formerly used in arthritis treatments, topical glucosamine has been found to reduce age spots and improve skin barriers.
While many products already on the market can improve tone imperfections, they have had a tendency to contain ingredients, such as hydroquinone, that can be harsh and irritating to the skin. This is among the first combinations to perfect skin tone while also improving the overall health of the skin.
The National Rosacea Society recently released a study highlighting results that dispell the common myth that rosacea typically affects adults age 30–50. The study also found the skin disorder may develop new signs and symptoms decades after its initial onset. 888-662-5874
A coffee habit, coupled with regular exercise, may help prevent skin cancers better than either factor alone, new research suggests.
The study was done only with animals, however, and it's not a reason to abandon standard sun-protection habits.
"You should not give up the sunblock," said Dr. Allan H. Conney, senior author of the study, published in this week's Proceedings of the National Academy of Sciences.
The findings aren't entirely new. "In earlier studies, we found caffeine and exercise -- either one by themselves -- inhibited ultraviolet light-induced skin cancer in mice," said Conney, the director of the Laboratory for Cancer Research at the School of Pharmacy at Rutgers, the State University of New Jersey.
But the new research shows that "the combination [of the two] works better," he said, providing a dramatically better anti-cancer result.
Both caffeine and exercise seem to help kill the UVB-damaged cells before malignancy sets in. "We really don't know how that happens," Conney said.
In the study, his team looked at four groups of hairless mice. The rodents' exposed skin is very vulnerable to the sun.
One group was given caffeinated water to drink each day, the equivalent of a person drinking a couple of cups of coffee a day, Conney said. Another group ran voluntarily on a running wheel, the equivalent of a person running two or two and a half miles every day, he said. (These mice will happily go on an exercise wheel if one is available, Conney said.) A third group had both the caffeine and the exercise, while a fourth group had neither and served as the control group.
The mice in all four groups were exposed to lamps that generated UVB radiation that damaged the skin cells' DNA.
While some degree of healthy, programmed skin cell death ("apoptosis") was seen in all four groups of mice, the caffeine drinkers and exercisers were best at killing off the damaged cells, the researchers found.
To find out how different the four groups were in terms of killing off damaged skin cells, the researchers looked at physical changes in those cells. They also looked at chemical markers, such as enzymes, involved in killing damaged cells.
The differences were dramatic. The caffeine drinkers showed a 96 percent increase in damaged cell death compared to the control group and the exercisers showed a 120 percent increase. Even more significant, the mice that drank caffeine and ran on the training wheel had a nearly 400 percent increase in cell death of damaged cells.
Whether this combination would work in people is not known, Conney said, although some research has found that caffeine and exercise does reduce certain cancer risks. He said he would like to do a clinical study in humans next.
More than a million non-melanoma skin cancers are diagnosed in the United States annually, according to the American Cancer Society. About 62,190 cases of melanoma, the most deadly skin cancer type, will be diagnosed this year.
A spokesman for the Skin Cancer Foundation urged caution in interpreting the study findings, however. "It will take years of extensive testing to determine whether this will be a worthwhile concept before you can say anything specific about it," said Dr. Michael Gold, founder of the Gold Skin Care Center in Nashville, Tenn.
"Mice and humans are very different. That said, we do know that caffeine applied topically has been popular as a 'cosmeceutical' anti-aging ingredient and might be useful in helping prevent non-melanoma skin cancers," Gold said. "The concept of systemic caffeine needs to be addressed further. We also know that moderate exercise is an immune moderator and can help ward off cancers and other diseases."
He echoed standard advice to wear sunscreen when out in the sun. "If you are exercising outside you must wear sunscreen no matter what," Gold said. "If you don't protect yourself from the sun while exercising outdoors you are increasing your risk of getting non-melanoma skin cancers and melanoma. Protecting yourself from the sun is currently the only proven way to prevent skin cancer."
By Kathleen Doheny, HealthDay News, July 30, 2007
Researchers have identified a protein that plays a key role in preventing skin cancer cells from dividing and multiplying.
Writing in the July 20 issue of Molecular Cell, a team at the University of Texas M.D. Anderson Cancer Center, reported that the protein IKKa prevented a vital "checkpoint" gene from shutting down and allowing cancer cells to spread.
The protein often is absent or only found at lower levels in a type of skin cancer cell.
IKKa is found at lower than normal levels in aggressive squamous cell carcinomas in both mice and humans. When operating normally, it allows the checkpoint gene 14-3-3o to respond to DNA damage in the cell. The gene usually creates a protein that blocks defective cells from dividing, allowing genetic errors to be repaired rather than copied.
Without IKKa proteins, the gene does not function optimally, and cells that multiply with damaged or abnormal genes are the root of cancer.
The interaction is part of the process of DNA methylation -- a process by which the work of a gene is chemically altered, but the gene itself is not damaged. Researchers look for ways to chemically turn the gene back on and restore its function.
The team inserted IKKa into deficient cells, which allowed the checkpoint gene to work again.
"What we've identified is a mechanism that promotes genetic instability in keratinocytes, a critical type of skin cell that makes up 90 percent of epidermal cells, during the development of human skin cancers," Yinling Hu, senior author of the paper and assistant professor in M.D. Anderson's department of carcinogenesis at the Science Park-Research Division in Smithville, Texas, said in a prepared statement. "Our finding opens a new avenue for identifying new therapeutic targets for battling cancer," Hu said.
The findings may have implications for a broad array of cancers, as the researchers noted that the checkpoint gene 14-3-3o is also shut dow n in cancerous epithelial cells. Epithelial cells are found in the outer layer of skin and in the linings of other body organs such as lungs, and the gastrointestinal, reproductive and urinary tracts.
HealthDay News, July 24, 2007
Natural Products Association launches testing program aimed at Increasing safety, quality and consumer confidence.