Hispanic Farmworkers at High Risk for Skin Disease

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

CE.R.I.E.S. Gives Research Award

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

Finding Hidden Melanomas

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.”

Nails
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.

Scalp
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.

Other Areas
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.”

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Recurrent Melanoma More Prevalent Than First Thought

Recurrent melanoma is more common than previously thought, with nearly 15 percent of people diagnosed with the potentially fatal skin cancer at risk of a second diagnosis within two years, a new study found.

About 6 percent of patients will develop a second melanoma within one year of the initial diagnosis, while 8 percent will be diagnosed with a second malignancy within two years, according to the researchers from Dartmouth Medical School in Hanover, N.H.

This rate is more frequent than previously thought and points to the importance of surveillance and skin screenings, according to the study in the April issue of Archives of Dermatology.

"This is not surprising, but it gives us another stimulus to be very vigilant about picking up second and third melanomas," said Dr. Vijay Trisal, assistant professor of surgical oncology at City of Hope Cancer Center, in Duarte, Calif. "Once it goes to the lymph nodes, we basically have no treatment." Trisal was not involved with the study.

Dr. Keyvan Nouri, director of Mohs and dermatologic surgery and associate professor of dermatology at the University of Miami Miller School of Medicine, added, "I don't think it [the new study] is going to affect the way doctors practice, but it's more data that says there's a real risk of recurrent melanomas."

Melanoma is a particularly virulent form of skin cancer. It begins in cells known as melanocytes, the pigment-producing cells that give skin its color, but can spread quickly and unpredictably to other organs of the body.

An estimated 62,000 Americans are diagnosed with melanoma each year, according to the American Cancer Society, and nearly 8,000 people die from the disease annually.

According to the new study, previous studies have put melanoma recurrence at less than 4 percent within one year.

The current study included 354 New Hampshire residents who'd had a previous diagnosis of melanoma. All participants answered questions about their medical history, sun exposure history, hair and eye color, and whether their skin tanned, burned or freckled in the sun. Then they underwent a skin examination by a physician.

Six percent of the participants developed an additional melanoma within one year of the first diagnosis, while 8 percent developed an additional melanoma within two years.

Roughly two-thirds of those who developed additional malignancies and 37 percent of those who did not had at least one atypical mole, which is a risk factor for additional melanomas. Someone with three or more atypical moles had four times the risk of developing an additional tumor. Atypical moles have at least three of the following features -- a diameter larger than 5 millimeters; redness; an irregular or ill-defined border; a variety of colors or a portion that is flat, the researchers said.

In one-third of the patients who developed another melanoma within two years, the subsequent melanoma was deeper than the first.

The study found little relationship between risk and benign moles, eye and hair color, or length of sun exposure. There was, however, a surprising inverse relationship between blistering sunburn and melanoma -- those with a history of sunburn were less likely to develop a second melanoma than those without, the researchers wrote. But this finding "must be viewed cautiously," the researchers said. It's possible that people who are predisposed to multiple melanomas may be less vulnerable to sunburn than those who get only one melanoma, or there may be a separate reason for the finding, the researchers said.

Another study in the same issue of the journal reported that nearly half of high schools surveyed in the Denver area contained advertisements for tanning parlors in their newspapers.

The ultraviolet (UV) radiation used in tanning parlors is a known carcinogen. The authors of the study, led by Dr. Scott Freeman, of the University of Colorado at Denver and Health Sciences Center, called for cancer-prevention policies that prohibited UV tanning advertising to minors.

The increasing incidence of melanoma in the United States also prompted the journal to publish an editorial calling for a national, five-year plan for "enhancing prevention and early detection for melanoma." The plan, the editorial stated, should start with a randomized trial of melanoma screening in white men aged 50 and over, who have the highest rates of the disease. The editorial also discussed the possibility of providing better insurance coverage -- including Medicare and Medicaid -- for such screening.

For individuals who have been diagnosed with melanoma, Trisal suggested surveillance every six months from a dermatologist. People who have been diagnosed with a second melanoma should consider getting checked every four months.

Nouri said, "Depending on the thickness of the melanoma, they should be seen every two to six months for the first two to three years to make sure there is no recurrence."

By Amanda Gardner, HealthDay News, April 17, 2006

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