Cosmetic Surgery Blog
The association between sun exposure and skin cancer has become more widely understood over the years as studies and research continue to be done.
In a recent cohort study, the long-term risk of developing skin cancer as a result of sunburns has been confirmed. The study used information gathered between 1991 to 2007 through a baseline questionnaire that included questions about the number of sunburns experienced. Follow-up questionnaires were answered every five to seven years. The data for this study was gathered by the Norwegian Women and Cancer Study which was established in 1991.
The analysis of the data from the study showed that those who experienced a high frequency of sunburns throughout their lives had a notably increased risk of developing cutaneous squamous cell carcinoma and melanoma. The data also showed that those who frequently experienced sunburns during childhood had an even higher risk of developing these skin cancers. The research indicates that properly protecting yourself from the sun and avoiding sunburns, especially during childhood, is incredibly important when it comes to reducing the risk of skin cancer.
Lifetime Sunburn Trajectories and Associated Risks of Cutaneous Melanoma and Squamous Cell Carcinoma Among a Cohort of Norwegian Women Simon Lergenmuller, PhD1,2; Corina S. Rueegg, PhD3; Flavie Perrier, PhD1; et alTrude E. Robsahm, PhD4; Adele C. Green, PhD5,6; Eiliv Lund, PhD4,7; Reza Ghiasvand, PhD3,4; Marit B. Veierød, PhD1
JAMA Dermatol. Published online October 5, 2022. doi:10.1001/jamadermatol.2022.4053
The link between alcohol consumption and an increased risk of melanoma can be attributed to multiple factors according to recent studies. While other studies have indicated that alcohol consumption increases the risk of sunburn due to ineffective sunscreen application and prolonged sun exposure, Dermatologist Dr. Niyati Sharma has noted that a German study has also found that alcohol consumption has also been linked to increased severity of sunburns.
One study has shown a 7% increase in the risk of basal cell carcinoma and an 11% increase in the risk of squamous cell carcinoma for every standard-sized beer, small glass of wine, or 10g of distilled spirit consumed daily. Another study also found that there was a 20% increase in the risk of melanoma in those who consumed liquor compared to those who abstained or consumed alcohol infrequently. That number rose to 55% in those who consumed 50g of alcohol per day.
The exact cause of this increased risk is not known yet, but Dr. Sharma has noted that a lower level of carotenoids in those who consume alcohol is likely the cause of increased sensitivity to developing more severe sunburns at an accelerated rate.
Mohs surgery is a procedure used to treat skin cancer. This surgery removes a narrow margin of normal looking skin beyond the obvious tumor. This tissue is processed in such a way that all of the outer margin and underside can be examined under the microscope. If residual cancer is seen reaching the outer edges a further thin margin is removed in that area only. The process is repeated until all the margins are proved to be clear.
Desmoplastic melanoma is a dangerous form of melanoma with a particularly high rate of local recurrence after standard surgical excision. While there have been previous studies showing Mohs surgery to be equal or better than regular wide excision for early regular melanomas, this is the first study indicating Mohs surgery also gives an advantage over wide surgical excision for desmoplastic melanoma as well.
In this retrospective single-institution study of 109 desmoplastic melanoma cases, 63 were treated with wide local excision (WLE) and 46 were treated with Mohs micrographic surgery (MMS). The local recurrence rate for WLE was 8%, and 11% of the patients required repeat surgery for local recurrence or positive/equivocal margins after WLE. No local recurrence was reported among patients treated with MMS; however, 1 patient required repeat surgery due to positive margins observed on permanent frozen sections.
Skin cancer is the most common type of cancer by a wide margin. There is a variety of different types of skin cancers that someone may develop at some point in their life. One of the most concerning types of skin cancer is melanoma.
Like other forms of cancer, melanoma forms when the cells in the body grow into a mass of cancerous cells. In the case of melanoma, the cells that are affected are the melanocytes, the pigment-producing cells responsible for producing melanin, which gives the skin a tan or darker color.
Melanomas can form on any area of the body, though they most commonly form in areas like the face, back, legs, arms, and other places that are frequently exposed to sunlight. They can also form on areas that do not receive large amount of sunlight, like the soles of the feet and the palms of the hands.
Symptoms and Signs of Melanoma
Some of the most common early signs of melanoma are a new dark spot on the skin or a noticeable change in an existing mole. These changes can pertain to the shape, size, or color of the dark spot or mole. Another indication could be a mole or dark spot that has a noticeably different appearance compared to others on the skin.
Other signs to look out for include an irregular border around the mole or dark spot, changing colors within the same mole, changes in shape and color over time, and asymmetry between different halves of a singular mole or dark spot.
The Importance of Regular Screenings for Melanoma
When it comes to treating melanoma, early detection is essential. If melanoma is caught early, the chance of successfully curing it is significantly higher. Some people also have a higher risk of developing melanoma, which makes early detection and regular screening for melanoma very important.
Just how important are regular screenings for melanoma? A study recently published in The British Journal of Dermatology studied 43,762 residents of Queensland, Australia, who were within the age range where the chance of developing melanoma was high. The study identified those who had undergone a skin cancer screening prior to the baseline set at the start of the study. Participants were also asked to fill out a comprehensive melanoma risk factors survey.
During the study, researchers calculated the incidence of confirmed melanoma cases among the patients being studied between the second and seventh years of the study. Researchers then measured the rate of biopsies performed amongst these patients between the second and sixth years of the study.
Once concluded, the study found that there was a clear higher rate of early detection in patients who underwent skin cancer screenings and a higher rate of biopsy in those patients. It should be noted that some of the melanomas discovered and treated through these screenings may have been indolent with a low chance of leading to death.
Taking the Steps to Protect Yourself
Whether you have a high risk of developing a melanoma or you just want to make sure that your skin and body are as healthy as possible, regular skin cancer screenings performed by a skin cancer expert are important for early detection. Dr. Massey is a renowned cosmetic and skin cancer surgeon who is dedicated to helping keep all of our patients safe and healthy. Contact our office today to schedule your skin cancer screening.
This is an important note to all of my patients because of the frequency of biotin use by the public. Many doctors have recommended biotin as a supplement for years as it is inexpensive and easy to use. It is a water-soluble vitamin, which while it does little harm, the therapeutic benefit is negligible and it can contaminate lab test results (see the list below). In addition, there are no easy fixes for many of the nail and hair problems that Biotin may be recommended to help.
The lab test interference goes beyond troponin and thyroid tests. This list is likely to grow. In light of this it is now generally recommended to stop biotin 2 days before getting any blood work done.
Lab tests affected by biotin supplementation
- Troponin (58.6%)
- 25-Hydroxy vitamin D
- Beta-human chorionic gonadotropin
- Human immunodeficiency virus serology
Journal of the American Academy of Dermatology
Biotin Beware: Perils of Biotin Supplementation
J Am Acad Dermatol 2022 Feb 24;[EPub Ahead of Print], JM Falotico, SR Lipner
Despite the many new treatment options for melanoma that have and will save many lives, the incidence of melanoma continues to rise. This is a worldwide problem, especially among fairer complected individuals.
In a recent article published in the Journal of the American Medical Association (JAMA), it was estimated that by the year 2040 the global burden from melanoma will increase to 510 000 new cases and 96 000 deaths.
The take-home message is that melanoma remains a significant problem and the incidence is likely going to rise significantly over the next 20 years. That’s important for us and our children!
The main preventative strategy available is to limit ultraviolet light exposure and avoid any sunburns.
For early detection, monitor your own moles and see your dermatologist if any of them are changing or start to itch or bleed. Remember when caught early melanoma is a very curable disease!
Melanoma in 2020 and Projections to 2040
Melina Arnold, PhD1; Deependra Singh, PhD1; Mathieu Laversanne, MSc1; et alJerome Vignat, MSc1; Salvatore Vaccarella, PhD1; Filip Meheus, PhD1; Anne E. Cust, PhD, MPH(Hons)2,3; Esther de Vries, PhD4; David C. Whiteman, MBBS(Hons), PhD5; Freddie Bray, PhD1
JAMA Dermatol. Published online March 30, 2022.
The complete removal of melanoma is a primary goal of excision, and local recurrence is one measure to evaluate the efficacy of surgical technique.
Through the comparison of published local recurrence rates for melanoma treated with Mohs micrographic surgery (MMS) or staged excision versus wide local excision (WLE) we can determine which method is more effective.
A search of 6 databases identified comparative and non-comparative studies that reported local recurrence rates after either technique. The pooled studies of over 16,000 patients showed a higher recurrence rate after Wide Local Excision (7%) compared with Staged Excision (3%) and compared with Mohs Surgery alone (<1%). The take home message is that Mohs Surgery and staged excision show lower local recurrence rates when used to treat melanoma when compared to wide local excision and it’s important in understanding which method your provider will use when you are seeking treatment
Local Recurrence of Melanoma Is Higher After Wide Local Excision Versus Mohs Micrographic Surgery or Staged Excision: A Systematic Review and Meta-analysis
RLD Pride, CJ Miller, MH Murad, PJ Erwin, JD Brewer
Dermatol Surg 2021 Nov 30;[EPub Ahead of Print]
Patients with a strong family history of melanoma may have germline mutations that put them at high risk for melanoma themselves. A study of these high-risk patients found that regular skin cancer screening exams and education lead to detection of melanoma at a significantly earlier stage than the melanomas detected without regular skin cancer screening. 83% of melanomas detected in the frequent screening group were at the early T1 stage whereas only 40% of melanomas in the regular group were in the early stage. The take-home message is: if you have a personal history or strong family history of melanoma, in addition to checking your own skin, it is well worth getting regular skin cancer screening exams by your dermatologist.
The Impact of Longitudinal Surveillance on Tumor Thickness for Melanoma-Prone Families with and without Pathogenic Germline Variants of CDKN2A and CDK4.
Michael R. Sargen, Ruth M. Pfeiffer, David E. Elder, Xiaohong R. Yang, Alisa M. Goldstein and Margaret A. Tucker
Cancer Epidemiol Biomarkers Prev 2021;30:676–81
Statin drugs are amongst the most commonly prescribed medications in America. Their primary role is in lowering high lipid levels to mitigate against the increased risk of heart disease associated with high lipids. However these same medications can have many other effects.
A recent study shows that in the laboratory melanoma cells that show genetic markers for the ability to metastasis, (spread beyond the skin), can have these genetic markers improved by exposure to statin drugs.
At the same time a chart review of 475 melanoma patients indicated that those taking statin drugs had a lower risk of developing metastasis compared to patients not taking statins. (24.7% for statin users vs 37.6% for those not taking statins.)
While this is all very preliminary, it suggests that taking statin drugs may do more than just protect your heart. They may lower the risk of metastasis in patients with melanoma. Obviously more research is needed to confirm this notion and calculate the risk benefit ratio of using statins in this way. None the less there is a good chance that a medication that has been out there for many years could help in the fight against melanoma.
Journal of Investigative Dermatology
Computational Drug Repositioning Identifies Statins as a Modifier of Prognostic Genetic Expression Signatures and Metastatic Behavior in Melanoma
J Invest Dermatol 2021 Jan 05;[EPub Ahead of Print], WY Yu, ST Hill, ER Chan, JJ Pink, K Cooper, S Leachman, AW Lund, R Kulkarni, JS Bordeaux