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Taking an extra 60 seconds to examine your feet when you clip your toenails could save your life, says the American College of Foot and Ankle Surgeons.
Routine self-examination of feet can help detect deadly melanoma skin cancer at an early stage, when it's easiest to cure. Half of people diagnosed with melanoma of the foot die within five years, because the cancer had already spread through their bodies by the time it was diagnosed, the college said.
In cases where melanoma is detected early, 92 percent of patients are still alive after five years.
Doing routine checks of your feet increases the likelihood that you'll spot suspicious moles, freckles or other irregularities. The college recommends you focus on the three most common areas for foot melanoma: the soles, between the toes, and around or under the toenails.
See a doctor immediately if you notice a mole, freckle or spot that starts to change over the course of a month and becomes asymmetrical or changes its border, color, diameter, or elevation.
Melanoma can develop anywhere on the body, including areas that receive little sun exposure, such as the feet and ankles.
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.”
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
Melanoma remains a stubborn foe, with doctors reporting limited success in preventing the sometimes fatal skin cancer and even less success developing a cure.
"We'd like to reduce that death rate, but that's not happening," said Dr. Martin A. Weinstock, chairman of the American Cancer Society's Skin Cancer Advisory Committee. "We're not being effective in preventing melanoma. We've been making progress in early detection but not as much as we would like. And therapy for melanomas not detected early is basically poor."
But several advances announced in the last year -- from testing "sentinel" lymph nodes as a way to jump-start aggressive treatment, to new gene therapies that may one day beat back the cancer -- have given doctors a cautious sense of optimism.
Still, the experts add that these treatments need more testing, and prevention remains the best way to avoid the disease. So, the message remains the same -- protect yourself from the sun, and keep an eye on unusual skin growths.
"There are a lot of therapies that are promising," said Weinstock, professor of dermatology and community health at Brown University and chief of dermatology at the VA Medical Center in Providence, R.I. "But they're all possibilities. We just don't know if they're going to pan out yet."
Skin cancers in general are extremely survivable. The U.S. National Cancer Institute estimates that more than 1 million new cases of non-melanoma skin cancer will be diagnosed in 2007, claiming fewer than 2,000 lives.
Melanoma is another matter. It's rarer than basal cell or squamous cell skin cancer, with about 59,900 new cases expected to strike Americans this year. But it will kill an estimated 8,110 people, according to the cancer institute.
Melanoma remains frustratingly hard to prevent and cure, Weinstock said.
It begins in skin cells called melanocytes that produce melanin, the pigment that gives skin its natural color. Skin exposed to the sun causes melanocytes to produce more pigment, creating a sun tan. Sometimes, clusters of melanocytes and surrounding tissues form moles on the skin.
Melanoma occurs when those pigment cells become malignant. The first sign of trouble often is a change in the size, shape, color or feel of an existing mole, with most melanomas displaying a black or blue-black area. Melanoma also can appear as a new mole that is black or looks abnormal or ugly, according to the cancer institute.
If undetected or left untreated, melanoma can spread to other parts of the body, such as the liver, lungs or brain. The first sign that melanoma has spread, or metastasized, usually is the appearance of cancer cells in the body's lymph nodes. Part of the body's defense system, the nodes produce lymph, which travels throughout the body and filters out impurities.
In the past, doctors fighting melanoma would remove many or all of the body's lymph nodes to help prevent the spread of the cancer. But the experimental sentinel node biopsy technique allows doctors to remove only a few lymph nodes directly affected by the melanoma.
In the procedure, a radioactive substance is injected near the melanoma and its progress through the body is tracked. The first lymph nodes to take up the substance are called the sentinel lymph nodes.
Since the cancer is most likely to head to those lymph nodes first, only those nodes are surgically removed for testing. If positive, the rest of the lymph nodes are tested and removed. But if negative, the patient avoids what can be a painful procedure.
Sentinel node biopsy has been around for about two decades, but new studies have shown that its use can give patients a better fighting chance against metastasized melanoma.
A 2006 study headed by Dr. Donald L. Morton, who helped create the technique, found that patients whose lymph nodes tested positive and then had the rest of their nodes removed enjoyed a much higher five-year survival rate, compared with people who tested positive but delayed removal of their lymph nodes.
"The risk of dying from melanoma was almost one-half reduced if you had the lymph nodes removed versus waiting for them to grow to a detectable size," said Morton, medical director and chief of the melanoma program at John Wayne Cancer Institute at Saint John's Health Center, in Santa Monica, Calif.
Other scientists have found that boosting the immune system's ability to recognize and destroy cancer cells shows promise in treating melanoma.
In a recent study, National Cancer Institute researchers treated 17 patients with advanced, metastatic melanoma with white blood cells called T-lymphocytes that had been genetically engineered to better recognize the skin cancer. The result: Two of the patients went into a sustained remission.
Doctors believe this shows that such gene therapy can work, but much more work and many refinements remain ahead.
Until these tactics are improved upon, Weinstock recommends that people use the American Cancer Society's recommended "Slip, Slop, Slap" strategy for fighting skin cancer.
"The one major avoidable cause of melanoma is exposure to ultraviolet radiation from the sun," Weinstock said. "Slip on a shirt, slop on the sunscreen and slap on a hat."
HealthDay News, By Dennis Thompson, July 22, 2007
The young woman in the American Cancer Society ad holds up a photo of a smiling woman. "My sister accidentally killed herself. She died of skin cancer," reads the headline.
The public-service announcement, financed by the sunscreen maker Neutrogena, is running in 15 women's magazines this summer. It warns readers that "left unchecked, skin cancer can be fatal," and urges them to "use sunscreen, cover up and watch for skin changes."
The woman in the picture is a model. And the ad's implicit message -- that those who die of skin cancer have themselves to blame -- has provoked a sharp response from some public-health doctors, who say the evidence simply does not support it. As the ad says, skin cancer is the most common form of cancer. But most skin cancer is not life-threatening: It represents less than 2 percent of all cancer deaths, an estimated 10,850 people this year. Almost all of those deaths are from melanoma, which makes up only 6 percent of all skin-cancer cases.
And the link between melanoma and sun exposure is not straightforward. Dr. Marianne Berwick, an epidemiologist at the University of New Mexico who studies skin cancer, led a study published in The Journal of the National Cancer Institute in 2005 finding that people who had a lot of sun exposure up to the time they got a diagnosis of melanoma actually had better survival rates than those who had little sun exposure. The researchers are conducting a large-scale follow-up aimed at clarifying the relationship between sun exposure and melanoma.
Until that is made clear, many doctors say, it is premature to suggest that people are endangering their lives by failing to use sunscreen.
"It's just not that simple," said Dr. Barry Kramer, associate director for disease prevention at the National Institutes of Health.
"We do have some pretty good evidence that sunscreen will reduce your risk of the less lethal forms of skin cancer," Kramer added. "There's very little evidence that sunscreens protect you against melanoma, yet you often hear that as the dominant message."
Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society, acknowledges that the advertisement is aggressive. "We have taken some license in taking that message and using it the way we've used it because that's the way to get the message to our target audience," he said.
The ad's creators settled on the approach with the help of focus groups, who told them: "To get the message through to me, you have to shock me and get my attention," he added.
"Our focus groups showed us that these young women as a group were oblivious to the risk and felt that skin cancer isn't a serious problem," Lichtenfeld said. "The issue is to try to prevent that sun exposure earlier in life so we reduce the risk for people later in life."
In an effort to spread awareness about sun safety, the cancer society has joined with Neutrogena, a division of Johnson & Johnson whose sunscreens carry the society's logo.
As part of the agreement, Neutrogena is paying for the public-service campaign, though its name is not mentioned in the advertisement.
The partnership benefited both parties, said Iris Grossman, director of communications for Johnson & Johnson. "We have the common goal of raising awareness," she said.
But this financial relationship raises red flags for some experts. "When people see an American Cancer Society public-service announcement, they expect it to reflect the best evidence," said Dr. Lisa Schwartz, co-director of the Outcomes Group at the Veterans Affairs hospital in White River Junction, Vt. "We don't want people who have a financial interest to be telling you the benefit of doing something."
Neutrogena did not influence the cancer society's message on skin cancer, Lichtenfeld said.
By Christie Aschwanden, New York Times News Service, July 17, 2007
The more moles a person has, the more likely their DNA has properties that help slow aging, according to a U.K. study of 1,800 twins.
People with more than 100 moles had longer telomeres than people with fewer than 25 moles, the study found. Telomeres -- bundles of DNA found at the end of chromosomes in all cells -- help keep chromosome ends from fraying and sticking to one another, BBC News reported.
Telomeres shorten as people age. The difference in telomere length between study volunteers with more than 100 moles and those with fewer than 25 moles was equivalent to six to seven years of aging, said the study, which appears in the journal Cancer Epidemiology Biomarkers and Prevention.
"The results of this study are very exciting as they show, for the first time, that moley people who have a slightly increased risk of melanoma may, on the other hand, have the benefit of a reduce rate of aging," said lead researcher Dr. Veronique Bataille of King's College London, BBC News reported.
"This could imply susceptibility to fewer age-related diseases, such as heart disease or osteoporosis, for example. Further studies are needed to confirm these findings," Bataille said.
HealthDay News, July 12, 2007