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Cosmetic Surgery Blog Santa Monica

Extremity moles linked to increase skin cancer risk.

The association between having lots of atypical moles all over your body and subsequent melanoma is well established. In a more recent prospective study the risk of moles on the extremities (arms and legs) was specifically looked at. Patients with more than 15 moles on their arms and legs had an almost 3 times risk for melanoma. These melanomas could occur anywhere on the body not just on the extremities, but having more than 15 extremity nevi (moles) identified patients who were at heightened risk.(There was also a small increase risk for basal cell carcinoma also noted but no increase risk of squamous cell cancer in this population). So take close look at your arms and legs and see if you can count to 15, it may be time to get checked!

Citation:

Journal of the American Academy of Dermatology 2019
Extremity Nevus Count Is an Independent Risk Factor for Basal Cell Carcinoma and Melanoma, but Not Squamous Cell Carcinoma
J Am Acad Dermatol 2019 Jan 31;[EPub Ahead of Print], EX Wei, X Li, H Nan

Melanoma in US Hispanics

While it is true that the darker your natural skin pigmentation the lower your risk of melanoma, no one is immune. In Hispanics, as expected the rate of melanoma is lower than non-Hispanic whites. However the melanomas that are diagnosed in this patient population are on average more advanced and the melanoma-specific survival is lower for Hispanics than for non-Hispanic whites. The reasons for this disparity are multi-factorial. Certainly providers may not consider the diagnosis of melanoma as readily in Hispanic patients and so hesitate to biopsy a lesion that they would have biopsied in a higher risk group. However discrepancy in the quality of care once the diagnosis is made is likely a factor in the poorer overall outcomes.

Take home message, whatever your skin type, if a lesion looks suspicious have it checked by a dermatologist. If a diagnosis of skin cancer is made have it treated by a dermatologist who specializes in the management of skin cancer.

Citation:

Melanoma in US Hispanics: Recommended Strategies to Reduce Disparities in Outcomes
Cutis 2018 Apr 01;101(4)243-246, VM Harvey

Facial exercise can make you look younger!

Mature woman sitting in countryside

You already know that working out your body can make you look and feel better. Now evidence that facial exercises can make you look younger. In this study, women aged 40-65 years old were given facial exercises to perform for 30 minutes for at least 3-4 times per week, for a total of 20 weeks. Of 27 enrolled volunteers 11 dropped out. (It takes a lot of commitment to work out your face for 30 minutes each day!). However the remaining 16 patients had a statistically significant effect. Comparing before and after photos the the women looked about 2 years younger. (Mean estimated age before study 50.8 years, mean estimated age after study 48.1). Admittedly not be a huge difference and maintaining a regimen of 30 minutes daily facial exercises my be too much of a commitment for many people. However for those who can keep it up, there is a free, non-invasive way to take a couple of years off!

Citation:

Association of Facial Exercise With the Appearance of Aging
Murad Alam, MD, MSCI, MBA1,2,3; Anne J. Walter, MD, MBA1,7; Amelia Geisler, BS1; et al Wanjarus Roongpisuthipong, MD1,4; Gary Sikorski5; Rebecca Tung, MD6; Emily Poon, PhD1
JAMA Dermatol. 2018;154(3):365-367. doi:10.1001/jamadermatol.2017. 5142

Beware of those Cosmic Rays!

Sunrise over Thailand out of a plane.

I often see pilots and cabin crew as patients for skin cancer treatment, and have suspected that the increased UV and cosmic radiation exposure at altitude with every flight might be a contributing factor. A recent analysis published by the British Journal of Dermatology confirms these suspicions. It seems that pilots and cabin crew have approximately double the risk of melanoma and keratocytic skin cancer (basal cell and squamous cell cancer) compared with the general population. While some of this risk may be theorized to be related to lay over days spent on the beach at exotic destinations, the magnitude of the increased risk implies that the repeated long hours at altitude is a significant factor. Flight crew, even more than the average person need to be especially vigilant in checking their own skin and see their dermatologist routinely for skin cancer screening.

Citation:

Do airline pilots and cabin crew have raised risks of melanoma and other skin cancers? Systematic review and meta‐analysis.
K. Miura C.M. Olsen S. Rea J. Marsden A.C. Green
First published British Journal of Dermatology: 26 December 2018 https://doi.org/10.1111/bjd. 17586

Indoor Tanning: Its worse than you think!

We already know that the extra UV exposure from indoor tanning increases your risk of skin cancer. New research now show that melanoma patients who had previously used indoor tanning had a much higher risk of developing a second melanoma and developed that second melanoma sooner than others. Approximately 65% of patients exposed to artificial UV (tanning beds) were diagnosed with a second primary melanoma within 1 year of the first diagnosis, compared with 28% of non-tanners. The median time to diagnosis of second primary melanoma in tanners vs non-tanners was 225 days vs 3.5 years, respectively. So avoid those tanning beds even if they try and tell you its safe, the effects may come back to haunt you years latter.

Article Citation:

Journal of the American Academy of Dermatology
Second Primary Melanomas: Increased Risk and Decreased Time to Presentation in Patients Exposed to Tanning Beds
J Am Acad Dermatol 2018 Oct 19;[EPub Ahead of Print], Y Li, M Kulkarni, K Trinkaus, LA Cornelius

Don’t Ignore that Itch!

The fact that itch may be associated with internal malignancy has previously been suspected. A recent study looked back at over 16,000 adult patient seen at the Johns Hopkins Health System from 2013-2017. They compared those with itch vs those without. Patients with pruritus (itch) were significantly more likely to have concomitant malignancy than those without pruritus. Most strongly associated were cancers of the liver, gallbladder and biliary tract, hematopoietic (blood) system, and skin. The study did not identify which came first, malignancy or itch, and did not identify the cause of the itch. Was it primarily the malignancy or the treatment or some other factor that cased the itching? None the less, the association has been confirmed such that patients with long term itching of no other apparent cause should be considered for a work up to rule out the most commonly associated malignancies.

Citation

Journal of the American Academy of Dermatology
Association Between Itch and Cancer in 16,925 Pruritus Patients: Experience at a Tertiary Care Center
J Am Acad Dermatol 2018 Sep 11;[EPub Ahead of Print], VA Larson, O Tang, S Stander, S Kang, SG Kwatra

Advanced Cutaneous Squamous Cell Cancer gets its own drug!

The use of “check point inhibitors” has revolutionized the approach to many advanced malignancies such as advanced melanoma. In fact this years Nobel prize was awarded to scientist who first developed this class of drugs.

These drugs work by allowing the immune-system to see the cancer cells and so initiate an attack against this otherwise hidden enemy. Now a new check point inhibitor, Libtayo (cemiplimab-rwlc) has gained FDA approval for the treatment of advanced squamous cell cancer of the skin.

This is the second most common form of skin cancer, and is usually cured with a relatively simple surgery. But in advanced cases that have metastasized, surgery alone is not adequate. This new check point inhibitor that may make a big difference for these patients. As mentioned in previous blog posts, helping the bodies immune system fight off cancer is likely to be the best chance of cure in many advanced cancers.

Helping the patients own immune-system fight cancer

cancer cell graphic

Cancer cells, particularly melanoma can be very skillful at avoiding recognition and attack by the bodies defenses. Novel immunotherapy with checkpoint blockade can help the patients’ immune system recognize and attack previously hidden cancer cells. A recent retrospective study demonstrates a significant improvement in 4 year overall survival in patients with advanced metastatic melanoma after FDA approval of these therapies. There is a long way to go, but now we can clearly see light at the end of the tunnel. It seems to me the ultimate “cancer cure” of the future will be through the patients own immune system, not chemotherapy, radiation or surgery.

Citation

Improved Risk-Adjusted Survival for Melanoma Brain Metastases in the Era of Checkpoint Blockade Immunotherapies: Results from a National Cohort
J. Bryan Iorgulescu, Maya Harary, Cheryl K. Zogg, Keith L. Ligon, David A. Reardon, F. Stephen Hodi, Ayal A. Aizer and Timothy R. Smith
Cancer Immunol Res September 1 2018 (6) (9) 1039-1045; DOI:10.1158/2326-6066.CIR-18-0067

Predictive Genes

Most patients with thin, early melanomas do very well, having a relatively low risk of disease spread or re-occurrence. However some of these “low risk” patients are not so lucky and end up with re-occurrence, or metastasis. In an effort to better predict which of the “low risk” patients were likely to be in this less fortunate sub-group, investigators used a 31-gene expression profile (31-GEP). The results suggest that the 31-GEP test may help identify high-risk individuals within groups previously considered to be low-risk. This could alert the patient and their treating physicians for the need for more careful follow up and even to consider adjunct treatment. Larger prospective studies will be needed to better understand how and when to use these test and what to do with the results. None the less it is getting us one step closer to better predicting patients risk and so will ultimately help guide management.

Citation:

Journal of the American Academy of Dermatology
Identification of Patients at Risk for Metastasis Using a Prognostic 31-Gene Expression Profile in Subpopulations of Melanoma Patients With Favorable Outcomes by Standard Criteria
J Am Acad Dermatol 2018 Aug 03;[EPub Ahead of Print], BR Gastman, P Gerami, SJ Kurley, RW Cook, S Leachman, JT Vetto

Inflammation Causing Skin Cancer

sun in sky

We know that UV light is the main driver of most skin cancers. UV rays from the sun or tanning beds causes mutations in the DNA of skin cells that are the cause of most skin cancers. However we also know that some skin cancers are not related to UV exposure. A link between chronic inflammation and skin cancers has long been recognized. Now a mechanism that may explain this has been elucidated in a recent study. Looking at skin samples from children with a rare skin condition, recessive dystrophic epidermolyisis bullosa investigators found that the skin cancers from the chronic inflammation in this condition were related to over activity of a protein called APOBEC. This protein normally plays a role in adding diversity to cellular proteins and is also thought to help defend against viruses. In chronic inflammation it appears to become overactive causing it to introduce mutations across the genome, some of which eventually lead to cancer.

There is hope that this new knowledge will help investigators work on better preventative strategies for the many cancers (in both skin and other tissues) that are related to chronic inflammation.

Citation:

APOBEC mutation drives early-onset squamous cell carcinomas in recessive dystrophic epidermolysis bullosa
Raymond J. Cho et al.
Science Translational Medicine 22 Aug 2018: Vol. 10, Issue 455

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