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Blacks and Hispanics with melanoma, the potentially deadly skin cancer, tend to have it diagnosed at a later, more advanced stage than whites, researchers report.
Over the past decade, melanoma has become more common, with the rate of new cases increasing 2.4 percent every year in the United States. Because whites are at higher risk for the disease, most prevention and detection efforts have targeted them.
This may be why survival rates among whites have increased from 68 percent in the 1970s to 92 percent today. Unfortunately, the same improvement in survival hasn't been replicated among blacks and Hispanics, the University of Miami researchers noted.
"We found that patients who were black and Hispanic were diagnosed later for melanoma than white patients in Miami-Dade County, Florida," said lead researcher Dr. Robert Kirsner, professor and vice chairman of dermatology and cutaneous surgery at the University of Miami Sylvester Comprehensive Cancer Center.
Their findings appear in the June issue of the Archives of Dermatology.
In their study, the researchers looked at 1,690 melanoma cases reported in Miami-Dade County between 1997 and 2002. Among these, 1,176 occurred in white patients, 485 in Hispanic patients and 29 in non-Hispanic black patients. The population of whites and blacks in Miami-Dade County is approximately the same.
Compared with whites, the Hispanic and black patients were more likely to have advanced-stage melanomas. Sixteen percent of Hispanics and 31 percent of blacks had cancer that had metastasized -- spread to other organs or tissues -- compared with 9 percent of whites.
Moreover, 52 percent of black patients had regional or distant-stage melanoma, the most severe stages, compared with 26 percent of Hispanic and 16 percent of white patients.
Kirsner isn't sure why these differences exist. It's possible that blacks and Hispanics have a more aggressive type of melanoma, he speculated. "More likely, there is less awareness among patients and health-care providers that melanoma can occur in ethnic populations and patients with darker pigmentation," Kirsner said.
As a consequence, these patients aren't screened as often, and lesions are not detected as early as in the white population, Kirsner said. "So a diagnosis is delayed until a late stage and that correlates with worse survival," he said. "Patients' diagnoses with thin melanomas have nearly a 100 percent survival. However, if it has spread, then survival goes down to 16 percent. So survival is worse in Hispanics and blacks."
This is a public health issue, Kisner said. "Greater awareness is needed both by doctors and patients. Awareness by patients and health-care providers can, hopefully, turn that tide and lead to the same improvement in survival that has been demonstrated in white populations."
Dr. Jeffrey C. Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine, agreed that it's important to educate blacks and Hispanics about the risk of melanoma.
"Clearly the awareness of melanoma risk in dark-skinned populations is less than in fair-skinned, sunburn-prone people. More could and should be done to raise the awareness that melanoma is not a disease exclusively of Caucasians," he said.
"Pigmentary changes on soles of feet, on palms, and under nails may be the only early warning sign of trouble in dark-skinned people," Salomon said. "This message needs to be sent out to people at risk. You can never make a diagnosis without thinking of it."
But another doctor thinks that since melanoma is largely a disease that strikes Causasians, it might be unwise to divert too many health-care dollars from education programs for whites.
"If you stop to think about how much impact you are going to have on melanoma by infusing money into the system, because melanoma is about 50 times more common in whites than in blacks, the fact is you have a lot more bang for your buck in reducing death from melanoma if that money is targeted at whites," said Dr. Jean-Claude Bystryn, a professor of dermatology at New York University School of Medicine.
Bystryn said spending the same amount of money on blacks and whites to reduce deaths from melanoma by 50 percent would save 500 lives among whites compared with 15 among blacks in Dade County.
"From a public health point of view, it is better to focus on the group that is most at risk," Bystryn said
HealthDay News, June 19, 2006
Skin cancer is the most common form of cancer suffered by people, accounting for more than half of all malignancies, according to the American Cancer Society.
So when you're out lounging in the sun this summer, working on that tan, remember that you're putting your body's largest organ at risk for cancer.
But preventing skin cancer can be as easy as limiting sun exposure between 10 a.m. and 2 p.m. and keeping a close eye on your skin for suspicious growths and moles. And recent research breakthroughs may aid treatment, particularly with melanoma, the most deadly form of skin cancer.
People rarely die from nonmelanoma skin cancer, which includes basal cell and squamous cell cancers. These malignancies claim the lives of about 2,800 Americans each year, compared with more than 1 million new cases diagnosed annually.
"Basal cell skin cancer is like a rust spot on a car door," said Dr. Ken Gross, a clinical professor of dermatology at the University of California, San Diego. "If you ignore it, it'll eat through that spot, but it will never reach the engine or the transmission."
Melanoma is a far more menacing threat. There are expected to be 62,190 new cases of melanoma diagnosed in the United States this year, and about 7,910 deaths from the cancer. Overall, the mortality rate for the disease has increased by 50 percent since the 1970s, according to the American Cancer Society.
However, new research could help treat, and perhaps prevent, melanoma. In a study published in the November issue of the New England Journal of Medicine, researchers found that there are at least several distinct types of melanoma, each potentially responding to its own individual treatment.
"It's very clear the landscape is changing because more and more genetic abnormalities are being found, and there are targeted therapies available for some of them," said study author Dr. Boris Bastian, an assistant professor of dermatology and pathology at the University of California, San Francisco.
Bastian found that there are differences between melanomas arising from skin on different parts of the body: chronically sun-damaged skin, skin without sun damage, skin rarely exposed to the sun, and mucous membranes.
"Therapies may only work for specific genetic abnormalities," Bastian said. "We're going to see, like in other cancer types, a breakup of the disease for treatment."
People at greatest risk for skin cancer are those who spend a lot of time in the sun and have fair skin. "We know that sunburn and chronic sun exposures bump up the risk of skin cancer," Gross said.
Family history also plays a part in determining whether you're apt to get skin cancer, he added. People with relatives who have contracted skin cancer should pay closer attention to abnormalities on their skin.
"Things that might be a little suspicious on someone else might be quite suspicious on you, and you might want to worry a little more," Gross said.
People with freckles or moles are at increased risk of melanoma, so they should inspect their moles often and keep track of any changes in them. You also should note any changes in your skin, including odd sores, lumps, blemishes or markings.
"Pay attention for the ugly duckling, the mole that doesn't fit in, the mole that has changed," Bastian said.
Once you've found a skin lesion or mole that gives you pause, you should go to a dermatologist as soon as possible to have it looked at, Gross said.
He recommends a dermatologist over your family physician because the specialist knows more about the different types of skin blemishes and cancers and can make a more informed diagnosis.
"Most patients come in saying, 'I've got a mole, and it's changing, that makes me suspicious. I want it biopsied,' " Gross said.
People might want to consider having regular skin screenings, particularly as they get older, he said. That way, doctors can track the progress of various blemishes and moles and note any suspicious changes.
Even if a growth has been removed, Gross recommends paying close attention to the place it came from. It could recur without warning.
"The most important thing you can remember is just because I say something is alright, that doesn't make it so," Gross said.
Gross said people who want to avoid skin cancer need only use common sense.
"When we go out, we wear a brimmed hat and long sleeves," he said. "I don't sunbathe, and I stay as far away from indoor tanning beds as possible."
Sunscreens can be useful, but are not a solution you should count on, Bastian said.
"Usually, people don't put on enough sunscreen," he said. "My recommendation is not to rely on sunscreens, but to avoid the sun during peak hours."
HealthDay News, June 16. 2006
British scientists have discovered a tantalizing new wrinkle in our understanding of smoking's unhealthy effects.
Middle-aged smokers whose faces were heavily wrinkled were five times as likely to have chronic obstructive pulmonary disease (COPD) than smokers whose faces were relatively smooth, the study found.
The authors speculated that both COPD and wrinkling may be linked by a common mechanism and that facial wrinkling might indicate susceptibility to the potentially deadly lung disease.
It's unclear, however, what kind of clinical relevance the findings hold.
"It's certainly biologically plausible," said Dr. Norman Edelman, chief medical officer for the American Lung Association. "This may be of use in educating patients but, in terms of detection of lung disease, we [already] have a simple breathing test. We don't have to look for wrinkles."
The research appears in the June 14 online edition of Thorax, which is published by the British Medical Journal.
COPD refers to a group of progressive chronic lung diseases, including emphysema and bronchitis, that block the airways and restrict oxygen flow.
Some 13.5 million Americans suffer from COPD, and the World Health Organization predicts that the condition will become the third leading cause of death worldwide by 2020.
Smoking is the biggest risk factor for COPD, and dermatologist have long noted that smoking causes premature aging of the skin.
However, not all smokers go on to develop COPD. "Obviously, people vary in their response to what's in the smoke," Edelman said.
In the study, the team wanted to see if genetic factors that predispose smokers to COPD might also predispose them to wrinkles.
The researchers, based at Royal Devon and Exeter NHS Foundation Trust, analyzed data on 149 current and former middle-aged smokers, 68 of whom (45.6 percent) had COPD. The participants came from 78 families.
Eighty-three percent had no facial wrinkling or only minor lines, but close to 17 percent had considerable wrinkling.
Lung strength and function, measured in all participants, turned out to be significantly lower in those with extensive wrinkling than in those with smoother faces.
People with heavy wrinkles were also five times more likely to have COPD than those without wrinkles. People with facial wrinkling also had triple the risk of suffering from more severe emphysema.
The authors theorized that smoking-linked changes in cells' collagen and elastin may be important for the development of both lung disease and wrinkles.
The findings are more likely to be helpful in spurring new research than in providing any direct benefit to patients, Edelman said.
"I think this will be of use to basic biologists," he explained. "Maybe you can start doing experiments on the skin, maybe that's an easier model to use than the lung to figure out what the mechanisms are."
HealthDay News, June 14, 2006
Women under 40 are showing higher incidences of nonmelanoma skin cancer, according to a new study appearing in The Journal of the American Medical Association. Rates for basal cell and squamous cell cancers have increased from 13 per 100,000 women to 32 per 100,000 over the last 30 years. Experts cite tanning as a possible reason for the rise. “Tan is still accepted as a sign of health and a sign of beauty,” says Leslie Christenson, MD, dermatologist and study author at the Mayo Clinic in Rochester, MN. Christenson recommends prevention at an early age, limiting sun exposure and always applying sunscreen.
American males aren't getting or heeding warnings on sun protection, researchers report, with the bulk of magazine ads for sunscreen appearing in publications aimed at women, not men.
A new U.S. study shows that 77% of the 783 sunscreen ads reviewed were published in women's magazines.
Researchers reviewed 579 magazines -- all May to September issues from 1997 to 2002 for 24 different publications.
While the average was about four ads for sunscreen per women's magazine, the average was less than one in each issue of parenting and family magazines. The average in outdoor and recreation magazines typically read by men was less than one per six issues.
"There's a huge opportunity to reach an untapped market," Alan Geller, an associate professor of research with the Boston University School of Medicine, said in a prepared statement. The ads should also better explain how to properly use sunscreen and other sun-care products, he said, as none of the ads contained the recommended guidelines for appropriate use of sunscreen.
His team published their findings in the May/June issue of the American Journal of Health Promotion.
"We know that men know much less about sun protection than women," Geller said, adding that "research has shown us that many, many people use sun protection products and still get burned." These advertisements provide a good opportunity to educate people on how to use sunscreen properly, he added.
"With my contacts, I've argued that advertising and communications should go on in boating, tennis and golf magazines," David J. Leffell, a professor of dermatology and surgery at the Yale School of Medicine, said in a prepared statement. Leffell was not involved in the study, but consults for a large U.S. manufacturer of sun-care products.
The results of the study show a need for working relationships between product marketing departments and advocates for skin cancer prevention, as well as more ads geared toward "potentially higher-risk groups such as children, men and outdoor recreation users," said Geller.
HealthDay News, May 29, 2006
Exposure to cats shortly after birth raises a child's risk of eczema, new research suggests.
The study, which tracked 486 children until the age of 1, was presented Sunday at the American Thoracic Society International Conference in San Diego.
While 27.6 percent of kids with cats as pets developed eczema in that time, only 17.8 percent of kids without cats developed the dry skin condition.
On the other hand, being around two or more dogs in the home conferred a slightly protective effect, said lead researcher Dr. Esmeralda Morales, a pediatric pulmonary fellow at the University of Arizona, in Tucson.
"Other studies have found that having cats or dogs at home seems to be protective against allergic disease, so we expected to have similar findings," Morales said in a statement.
Morales noted that the children in the study who developed eczema by the age of 1 might still wind up having a reduced risk of asthma or allergies later in life. "The findings do seem to add more questions about pets and asthma and allergies. Since there are a lot of contradictory data out there already, clearly it's a topic that needs further research," she added.
Skin disease affects more than three out of four Hispanic farmworkers in North Carolina, researchers say, highlighting the need for those workers to get more information on preventing skin ailments, including skin cancer.
A team at Wake Forest University in Winston-Salem, N.C., conducted two studies including a total of 89 farmworkers.
They found that "farmworkers are particularly vulnerable to diseases of the skin and have the highest incidence of skin disorders of any industry," lead researcher Thomas Arcury, professor of family medicine, said in a prepared statement. "These workers represent a medically underserved population that is at risk for both environmental and occupational health problems, as well as health problems associated with poverty," he said.
The findings appear in the May issue of the Journal of Agricultural Safety and Health and in the April issue of the American Journal of Industrial Medicine.
The first study included five female farmworkers and 54 male workers. All five females and 78 percent of the males had some form of skin disease. Among males, the most common conditions were nail fungus, foot fungus and acne, while excessively dry skin, foot fungus and acne were among the conditions diagnosed in the females.
"While these may not be a direct result of farm work, it is likely a result of resources and living environment," Arcury said.
He noted that the farmworkers usually have to share shower facilities and often have limited access to laundry facilities and detergents.
In the second study, researchers interviewed 30 farmworkers to learn more about their knowledge about skin disease. Even though they spend so much time outdoors, few of the farm workers mentioned skin cancer as a potential health problem. The interviews also revealed a common belief among the workers that an individual's susceptibility determines whether they're affected by a skin condition.
"Farmworkers do not acknowledge several skin diseases that should be of great concern, including skin cancer. And personal susceptibility is used to differentiate one's self from others, usually to show superiority," Arcury said.
Any programs designed to reduce occupational skin diseases among farmworkers must challenge these beliefs.
"First, the notion that it affects only those who are susceptible needs to be dispelled. Second, the delayed effects of some risk factors, such as sunlight exposure, need to be stressed," Arcury said.
Yahoo HealthDay News, May 12, 2006
Centre de Recherches et d’Investigations Épidermiques et Sensorielles (CE.R.I.E.S.) announces its CE.R.I.E.S. 2006 Research Award—created to honor a researcher in dermatology and help fund future research projects focused on healthy skin. This year, Masayuki Amagai, MD, PhD, of Tokyo, received this coveted award totaling $52,000. +33 (0) 1 46 43 49 00
The last place one might look for melanoma, the most serious form of skin cancer, is exactly the place where a small percentage shows up – such as under the nails, on the scalp, palms of the hands and soles of the feet. Since they are not easily detected and symptoms can mimic other conditions, these skin cancers are very dangerous. If left undetected, hidden melanomas can pose a serious threat to a person’s health and prognosis.
“People need to know that melanoma is not limited to sun-exposed areas of the body,” said dermatologist Stephen P. Stone, M.D., president of the American Academy of Dermatology (Academy). “That’s why the Academy is advising everyone to conduct regular self-examinations and be aware of the areas of the body where melanoma can hide.”
Melanoma that manifests itself within the nail plate, which is known as subungal melanoma, accounts for a fraction of all skin cancer cases – 2% in Caucasians and 30-40% in people with skin of color. While these melanomas most commonly occur under the nail of the thumb or big toe, they are often characterized by the appearance of a brown- or black-colored streak within the nail plate that is often mistaken for a bruise caused by an injury to the nail.
Melanoma that occurs on the scalp also is difficult to detect, as it is easily hidden by hair. Since symptoms do not usually appear until the melanoma has progressed to an advanced stage, dermatologists recommend that everyone examines the scalp during a self-exam – using a blow dryer to part the hair away from the scalp and a mirror for hard-to-see areas.
Symptoms of melanoma occurring on the scalp include a pigmented lesion that has recently appeared or changed or a lesion that bleeds. To determine if whether or not a mole is suspicious, it is helpful to keep in mind the ABCDs of melanoma:
- Asymmetry – meaning one half of a mole is different than another;
- Border Irregularity – the edge, or border, of melanomas are usually ragged, notched or blurred;
- Color – benign moles can be any color, but a single mole will be only one color. Melanoma often has a variety of hues and colors within the same lesion; and
- Diameter – while melanomas are usually greater than 6 mm (a pencil eraser) in diameter when diagnosed, they can be smaller. If a mole is different from others, or it changes, itches or bleeds, even if it is smaller than 6 mm, see a dermatologist.
Melanoma also can occur in other unusual areas, such as in the eyes, on the palms of the hands or the soles of the feet, or the mucosal tissue lining the nose, mouth, genitalia, anus, urinary tract and esophagus.
“With these types of hidden melanomas, symptoms often include bleeding, pain or an unusual sensation without a known cause,” said Dr. Stone. “It’s extremely important to seek the proper medical attention for problems that arise in these areas to rule out melanoma or another serious medical condition.”
To raise awareness about the importance of skin cancer screenings, nearly 2,000 dermatologists provide free skin cancer screenings across the country as part of the Academy’s National Skin Cancer Screening Program. On Saturday, May 6, 2006, the Academy will attempt to set a Guinness World Record for the most people screened for skin cancer in a single day. To locate a free screening, the public can visit www.aad.org/worldrecord.
It is estimated that there will be about 111,900 new cases of melanoma diagnosed in 2006, representing a more than 9 percent increase in new cases of melanoma since 2005. This year alone, nearly 8,000 deaths will be attributed to melanoma, yet when detected early, skin cancer has a 95 percent cure rate. “The earlier you detect skin cancer, the better your chances of complete cure,” said Dr. Stone. “That’s why we recommend everyone conduct self-examinations and see a dermatologist if you find something suspicious.”
A recent survey conducted by the National Rosacea Society and published in Rosacea Review indicates that 93% of participants experienced at least some physical discomfort due to rosacea. The most common symptoms were facial burning, facial itching, stinging, swelling and tenderness.