User login
SDEF: Previous BCC, SCC Boosts Melanoma Metastasis Risk
WAIKOLOA, HAWAII - Melanomas are more likely to be fatal when they occur in patients with a history of nonmelanoma skin cancer.
He cited a recent University of Pennsylvania nested case-control study involving 549 patients who presented with nonmetastatic melanoma and subsequently developed metastatic disease at least 6 months after definitive surgery. Each of the patients was matched to a control subject who had melanoma that did not metastasize.
The study identified two novel risk factors for melanoma metastasis: prior nonmelanoma skin cancer and a history of malignancy other than skin cancer. In a multivariate, logistic, regression analysis adjusted for 34 variables, a past medical history of nonmelanoma skin cancer was independently associated with a 2.89-fold increased risk of metastasis. Prior cancer at a non-cutaneous site conferred a 3.68-fold increased risk.
Previously established risk factors for melanoma metastasis were reaffirmed in this study. For example, tumor ulceration was associated with a 2.85-fold increased risk, male gender had a 1.8-fold risk, a vertical growth phase tumor had a 7.67-fold risk, and the presence of microscopic satellites was associated with a 6.62-fold increased risk of metastasis, noted Dr. Grichnik, professor of dermatology at the University of Miami and director of the melanoma program at the Sylvester Comprehensive Cancer Center.
Early metastases, defined as being diagnosed within 3 years after definitive surgery, developed in 320 melanoma patients. Another 70 patients developed late metastases, arising 8 years or more post-surgery. The strongest predictor of early, as compared to late, metastasis was a history of non-melanoma skin cancer, with a 4.83-fold increased risk. Patients with early metastasis were also significantly more likely to have ulcerated lesions and thicker tumors (Cancer 2010;116:415-23).
Also useful in identifying aggressive melanomas are the American Joint Committee on Cancer Staging criteria, based largely on tumor thickness, nodal involvement, and metastases, Dr. Grichnik said. Other factors worth considering include tumor mitotic rate, the presence or absence of circulating tumor cells, and molecular marker status.
Dr. Grichnik disclosed having financial relationships with DigitalDerm Inc., Spectral Image Inc., and Electro-Optical Sciences.
SDEF and this news organization are owned by Elsevier.
WAIKOLOA, HAWAII - Melanomas are more likely to be fatal when they occur in patients with a history of nonmelanoma skin cancer.
He cited a recent University of Pennsylvania nested case-control study involving 549 patients who presented with nonmetastatic melanoma and subsequently developed metastatic disease at least 6 months after definitive surgery. Each of the patients was matched to a control subject who had melanoma that did not metastasize.
The study identified two novel risk factors for melanoma metastasis: prior nonmelanoma skin cancer and a history of malignancy other than skin cancer. In a multivariate, logistic, regression analysis adjusted for 34 variables, a past medical history of nonmelanoma skin cancer was independently associated with a 2.89-fold increased risk of metastasis. Prior cancer at a non-cutaneous site conferred a 3.68-fold increased risk.
Previously established risk factors for melanoma metastasis were reaffirmed in this study. For example, tumor ulceration was associated with a 2.85-fold increased risk, male gender had a 1.8-fold risk, a vertical growth phase tumor had a 7.67-fold risk, and the presence of microscopic satellites was associated with a 6.62-fold increased risk of metastasis, noted Dr. Grichnik, professor of dermatology at the University of Miami and director of the melanoma program at the Sylvester Comprehensive Cancer Center.
Early metastases, defined as being diagnosed within 3 years after definitive surgery, developed in 320 melanoma patients. Another 70 patients developed late metastases, arising 8 years or more post-surgery. The strongest predictor of early, as compared to late, metastasis was a history of non-melanoma skin cancer, with a 4.83-fold increased risk. Patients with early metastasis were also significantly more likely to have ulcerated lesions and thicker tumors (Cancer 2010;116:415-23).
Also useful in identifying aggressive melanomas are the American Joint Committee on Cancer Staging criteria, based largely on tumor thickness, nodal involvement, and metastases, Dr. Grichnik said. Other factors worth considering include tumor mitotic rate, the presence or absence of circulating tumor cells, and molecular marker status.
Dr. Grichnik disclosed having financial relationships with DigitalDerm Inc., Spectral Image Inc., and Electro-Optical Sciences.
SDEF and this news organization are owned by Elsevier.
WAIKOLOA, HAWAII - Melanomas are more likely to be fatal when they occur in patients with a history of nonmelanoma skin cancer.
He cited a recent University of Pennsylvania nested case-control study involving 549 patients who presented with nonmetastatic melanoma and subsequently developed metastatic disease at least 6 months after definitive surgery. Each of the patients was matched to a control subject who had melanoma that did not metastasize.
The study identified two novel risk factors for melanoma metastasis: prior nonmelanoma skin cancer and a history of malignancy other than skin cancer. In a multivariate, logistic, regression analysis adjusted for 34 variables, a past medical history of nonmelanoma skin cancer was independently associated with a 2.89-fold increased risk of metastasis. Prior cancer at a non-cutaneous site conferred a 3.68-fold increased risk.
Previously established risk factors for melanoma metastasis were reaffirmed in this study. For example, tumor ulceration was associated with a 2.85-fold increased risk, male gender had a 1.8-fold risk, a vertical growth phase tumor had a 7.67-fold risk, and the presence of microscopic satellites was associated with a 6.62-fold increased risk of metastasis, noted Dr. Grichnik, professor of dermatology at the University of Miami and director of the melanoma program at the Sylvester Comprehensive Cancer Center.
Early metastases, defined as being diagnosed within 3 years after definitive surgery, developed in 320 melanoma patients. Another 70 patients developed late metastases, arising 8 years or more post-surgery. The strongest predictor of early, as compared to late, metastasis was a history of non-melanoma skin cancer, with a 4.83-fold increased risk. Patients with early metastasis were also significantly more likely to have ulcerated lesions and thicker tumors (Cancer 2010;116:415-23).
Also useful in identifying aggressive melanomas are the American Joint Committee on Cancer Staging criteria, based largely on tumor thickness, nodal involvement, and metastases, Dr. Grichnik said. Other factors worth considering include tumor mitotic rate, the presence or absence of circulating tumor cells, and molecular marker status.
Dr. Grichnik disclosed having financial relationships with DigitalDerm Inc., Spectral Image Inc., and Electro-Optical Sciences.
SDEF and this news organization are owned by Elsevier.
3.75% Imiquimod Cream Approved by FDA
A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.
In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.
The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.
“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.
A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.
In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.
The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.
“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.
A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.
In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.
The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.
“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.
Why CTCL Can Be Such a Challenging Diagnosis
Dr. John A. Zic on the controversies in cutaneous T-cell lymphoma, particularly the difficulty in diagnosis. Dr. Zic disclosed that he is an investigator for Therakos, and he serves on the advisory board for Eisai.
Dr. John A. Zic on the controversies in cutaneous T-cell lymphoma, particularly the difficulty in diagnosis. Dr. Zic disclosed that he is an investigator for Therakos, and he serves on the advisory board for Eisai.
Dr. John A. Zic on the controversies in cutaneous T-cell lymphoma, particularly the difficulty in diagnosis. Dr. Zic disclosed that he is an investigator for Therakos, and he serves on the advisory board for Eisai.
"Ban the Tan" Movement Continues
Skin & Allergy News continues its multimedia coverage of the "Ban the Tan 2010" movement. On March 25, we talked with AAD President Dr. William James who discussed the testimony he gave before an FDA panel on why he thinks indoor tanning should be banned.
Skin & Allergy News continues its multimedia coverage of the "Ban the Tan 2010" movement. On March 25, we talked with AAD President Dr. William James who discussed the testimony he gave before an FDA panel on why he thinks indoor tanning should be banned.
Skin & Allergy News continues its multimedia coverage of the "Ban the Tan 2010" movement. On March 25, we talked with AAD President Dr. William James who discussed the testimony he gave before an FDA panel on why he thinks indoor tanning should be banned.
FDA Panel Backs Stricter Regulation of UV Tanning Devices
GAITHERSBURG, Md. – A Food and Drug Administration advisory panel has recommended tougher restrictions on indoor tanning devices, including a ban on their use by people under age 18.
At a meeting March 25, most members of the FDA’s General and Plastic Surgery Devices Panel supported such a ban as one measure to address the widespread use and potential skin cancer risks of indoor tanning.
Other panelists recommended different controls to protect this age group from exposure to these devices, including required informed parental consent. The FDA usually follows the recommendations of its advisory panels, which are not binding.
The meeting was held to discuss whether current labeling of tanning beds and lamps adequately addresses their known risks and to discuss increasing concerns about the heightened skin cancer risks associated with the devices.
The advisory panel unanimously recommended moving indoor tanning devices to a higher risk category, subjecting them to more controls and requirements.
Currently, UV lamps and beds used for tanning are regulated by the FDA as Class I devices, the lowest risk category. Band-Aids are also regulated as Class I devices. Panelists were divided between recommending reclassifying tanning devices as Class II devices, which require special controls, or as Class III, the highest risk category. Examples of Class II devices include medical lasers and UV lamps used to treat dermatologic disorders; Class III devices include breast implants and injectable cosmetic fillers.
The American Academy of Dermatology and other medical associations recommend a broad ban on the sale and use of these products for tanning, but at a minimum, the AAD says, they should be banned for use in minors under age 18.
Among those speaking during the public hearing portion of the meeting was AAD President Dr. William James of the University of Pennsylvania, Philadelphia, who said that dermatologists are seeing more young women with advanced skin cancer, including melanoma, who have used indoor tanning devices.
The chief of the dermatology service at Memorial-Sloan Kettering, New York, Dr. Allan Halpern, testified that 25% of melanomas in young women could be attributed to UV tanning bed use.
Of the more than 1 million people per day in the United States who are exposed to UV radiation from indoor tanning devices, 70% are women, and most are between ages 16 and 29. A total of 24% of female adolescents ages 13-19 have used a tanning bed at least once in the previous year, according to the AAD.
FDA officials at the meeting said they believe there’s evidence of a potential raised risk for skin cancer associated with increased UV exposure acquired with UV tanning lamps.
Standards for indoor tanning devices in Europe are more restrictive than in the United States and include age restrictions and requirements for informed consent in some countries, according to the FDA.
Members of FDA advisory panels have been cleared of potential conflicts of interest related to the products under discussion prior to the meeting.
GAITHERSBURG, Md. – A Food and Drug Administration advisory panel has recommended tougher restrictions on indoor tanning devices, including a ban on their use by people under age 18.
At a meeting March 25, most members of the FDA’s General and Plastic Surgery Devices Panel supported such a ban as one measure to address the widespread use and potential skin cancer risks of indoor tanning.
Other panelists recommended different controls to protect this age group from exposure to these devices, including required informed parental consent. The FDA usually follows the recommendations of its advisory panels, which are not binding.
The meeting was held to discuss whether current labeling of tanning beds and lamps adequately addresses their known risks and to discuss increasing concerns about the heightened skin cancer risks associated with the devices.
The advisory panel unanimously recommended moving indoor tanning devices to a higher risk category, subjecting them to more controls and requirements.
Currently, UV lamps and beds used for tanning are regulated by the FDA as Class I devices, the lowest risk category. Band-Aids are also regulated as Class I devices. Panelists were divided between recommending reclassifying tanning devices as Class II devices, which require special controls, or as Class III, the highest risk category. Examples of Class II devices include medical lasers and UV lamps used to treat dermatologic disorders; Class III devices include breast implants and injectable cosmetic fillers.
The American Academy of Dermatology and other medical associations recommend a broad ban on the sale and use of these products for tanning, but at a minimum, the AAD says, they should be banned for use in minors under age 18.
Among those speaking during the public hearing portion of the meeting was AAD President Dr. William James of the University of Pennsylvania, Philadelphia, who said that dermatologists are seeing more young women with advanced skin cancer, including melanoma, who have used indoor tanning devices.
The chief of the dermatology service at Memorial-Sloan Kettering, New York, Dr. Allan Halpern, testified that 25% of melanomas in young women could be attributed to UV tanning bed use.
Of the more than 1 million people per day in the United States who are exposed to UV radiation from indoor tanning devices, 70% are women, and most are between ages 16 and 29. A total of 24% of female adolescents ages 13-19 have used a tanning bed at least once in the previous year, according to the AAD.
FDA officials at the meeting said they believe there’s evidence of a potential raised risk for skin cancer associated with increased UV exposure acquired with UV tanning lamps.
Standards for indoor tanning devices in Europe are more restrictive than in the United States and include age restrictions and requirements for informed consent in some countries, according to the FDA.
Members of FDA advisory panels have been cleared of potential conflicts of interest related to the products under discussion prior to the meeting.
GAITHERSBURG, Md. – A Food and Drug Administration advisory panel has recommended tougher restrictions on indoor tanning devices, including a ban on their use by people under age 18.
At a meeting March 25, most members of the FDA’s General and Plastic Surgery Devices Panel supported such a ban as one measure to address the widespread use and potential skin cancer risks of indoor tanning.
Other panelists recommended different controls to protect this age group from exposure to these devices, including required informed parental consent. The FDA usually follows the recommendations of its advisory panels, which are not binding.
The meeting was held to discuss whether current labeling of tanning beds and lamps adequately addresses their known risks and to discuss increasing concerns about the heightened skin cancer risks associated with the devices.
The advisory panel unanimously recommended moving indoor tanning devices to a higher risk category, subjecting them to more controls and requirements.
Currently, UV lamps and beds used for tanning are regulated by the FDA as Class I devices, the lowest risk category. Band-Aids are also regulated as Class I devices. Panelists were divided between recommending reclassifying tanning devices as Class II devices, which require special controls, or as Class III, the highest risk category. Examples of Class II devices include medical lasers and UV lamps used to treat dermatologic disorders; Class III devices include breast implants and injectable cosmetic fillers.
The American Academy of Dermatology and other medical associations recommend a broad ban on the sale and use of these products for tanning, but at a minimum, the AAD says, they should be banned for use in minors under age 18.
Among those speaking during the public hearing portion of the meeting was AAD President Dr. William James of the University of Pennsylvania, Philadelphia, who said that dermatologists are seeing more young women with advanced skin cancer, including melanoma, who have used indoor tanning devices.
The chief of the dermatology service at Memorial-Sloan Kettering, New York, Dr. Allan Halpern, testified that 25% of melanomas in young women could be attributed to UV tanning bed use.
Of the more than 1 million people per day in the United States who are exposed to UV radiation from indoor tanning devices, 70% are women, and most are between ages 16 and 29. A total of 24% of female adolescents ages 13-19 have used a tanning bed at least once in the previous year, according to the AAD.
FDA officials at the meeting said they believe there’s evidence of a potential raised risk for skin cancer associated with increased UV exposure acquired with UV tanning lamps.
Standards for indoor tanning devices in Europe are more restrictive than in the United States and include age restrictions and requirements for informed consent in some countries, according to the FDA.
Members of FDA advisory panels have been cleared of potential conflicts of interest related to the products under discussion prior to the meeting.
AAD: Vitamin D Deficiency Plagues Patients With Skin of Color
Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.
African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.
Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.
In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.
More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.
Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.
In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.
Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.
The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.
Patients should be advised about the best sources of dietary vitamin D, including fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.
"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.
"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.
Dr. Grimes reported she had no disclosures related to her presentation.
Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.
African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.
Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.
In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.
More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.
Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.
In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.
Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.
The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.
Patients should be advised about the best sources of dietary vitamin D, including fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.
"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.
"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.
Dr. Grimes reported she had no disclosures related to her presentation.
Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.
African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.
Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.
In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.
More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.
Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.
In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.
Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.
The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.
Patients should be advised about the best sources of dietary vitamin D, including fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.
"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.
"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.
Dr. Grimes reported she had no disclosures related to her presentation.
Skin Cancer History Ups Risk for Melanoma With Metastasis
Melanoma patients who have a prior history of nonmelanoma skin cancers are at a three-fold increased risk of having a metastasis. Dr. James Grichnik spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Melanoma patients who have a prior history of nonmelanoma skin cancers are at a three-fold increased risk of having a metastasis. Dr. James Grichnik spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Melanoma patients who have a prior history of nonmelanoma skin cancers are at a three-fold increased risk of having a metastasis. Dr. James Grichnik spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Role of Confocal Microscopy in Lesion Management
In an interview, Dr. Lawrence T. Wang discusses the role of confocal microscopy for the management of pigmented lesions, including melanoma.
In an interview, Dr. Lawrence T. Wang discusses the role of confocal microscopy for the management of pigmented lesions, including melanoma.
In an interview, Dr. Lawrence T. Wang discusses the role of confocal microscopy for the management of pigmented lesions, including melanoma.
AAD: Skin Toxicities From Anticancer Treatment Prove Costly
MIAMI - The cost of treating dermatologic toxicities associated with targeted anticancer therapies contributes significantly to the overall financial burden of cancer care, cost analysis data from 131 affected patients suggest.
The overall cost of caring for treatment-related dermatologic toxicities in the 30-month study was more than $337,409, or $2,576 per patient, Dr. Judy H. Borovicka reported at the annual meeting of the American Academy of Dermatology.
The analysis included the cost of clinic visits, laboratory tests, diagnostic and therapeutic procedures, medications, and supplies, said Dr. Borovicka, a clinical trial investigator at Northwestern University, Chicago.
Patients had a total of 481 visits (for an average of 3.7 per person) to a subspecialty clinic developed to treat skin and eye reactions to inhibitors of epidermal growth-factor receptor and kinases (the SERIES Clinic in Chicago) between November 2005 and April 2008, for a mean cost per visit of $701. All were diagnosed with 1 of 15 primary cancer types, and were treated with rituximab, erlotinib, imatinib, lapatinib, panitumumab, sorafenib, or sunitinib.
The more common dermatologic toxicities associated with these drugs included papulopustular rash, periungual inflammation, xerosis, alopecia, and ocular changes. Papulopustular rash was the most common toxicity, occurring in 45%-100% of patients.
Sorafenib induced the most costly dermatologic toxicities, with a mean overall patient cost of $2,974; lapatinib and imatinib were associated with the least costly toxicities, with mean overall costs of $1,275 and $1,490, respectively, Dr. Borovicka said, noting that the differences in cost between sorafenib and lapatinib/imatinib were statistically significant.
Toxicity severity was predictive of increased patient cost; however, age, gender, race/ethnicity, cancer type, and cancer severity were not predictors of patient cost, Dr. Borovicka said.
"Toxicities impact the quality of life of patients undergoing treatment with targeted anticancer therapies, and they carry significant financial implications... management of untoward effects is paramount to minimizing the disruption of therapy," she concluded.
Dr. Borovicka stated that she has no relevant financial or other disclosures related to this study.
MIAMI - The cost of treating dermatologic toxicities associated with targeted anticancer therapies contributes significantly to the overall financial burden of cancer care, cost analysis data from 131 affected patients suggest.
The overall cost of caring for treatment-related dermatologic toxicities in the 30-month study was more than $337,409, or $2,576 per patient, Dr. Judy H. Borovicka reported at the annual meeting of the American Academy of Dermatology.
The analysis included the cost of clinic visits, laboratory tests, diagnostic and therapeutic procedures, medications, and supplies, said Dr. Borovicka, a clinical trial investigator at Northwestern University, Chicago.
Patients had a total of 481 visits (for an average of 3.7 per person) to a subspecialty clinic developed to treat skin and eye reactions to inhibitors of epidermal growth-factor receptor and kinases (the SERIES Clinic in Chicago) between November 2005 and April 2008, for a mean cost per visit of $701. All were diagnosed with 1 of 15 primary cancer types, and were treated with rituximab, erlotinib, imatinib, lapatinib, panitumumab, sorafenib, or sunitinib.
The more common dermatologic toxicities associated with these drugs included papulopustular rash, periungual inflammation, xerosis, alopecia, and ocular changes. Papulopustular rash was the most common toxicity, occurring in 45%-100% of patients.
Sorafenib induced the most costly dermatologic toxicities, with a mean overall patient cost of $2,974; lapatinib and imatinib were associated with the least costly toxicities, with mean overall costs of $1,275 and $1,490, respectively, Dr. Borovicka said, noting that the differences in cost between sorafenib and lapatinib/imatinib were statistically significant.
Toxicity severity was predictive of increased patient cost; however, age, gender, race/ethnicity, cancer type, and cancer severity were not predictors of patient cost, Dr. Borovicka said.
"Toxicities impact the quality of life of patients undergoing treatment with targeted anticancer therapies, and they carry significant financial implications... management of untoward effects is paramount to minimizing the disruption of therapy," she concluded.
Dr. Borovicka stated that she has no relevant financial or other disclosures related to this study.
MIAMI - The cost of treating dermatologic toxicities associated with targeted anticancer therapies contributes significantly to the overall financial burden of cancer care, cost analysis data from 131 affected patients suggest.
The overall cost of caring for treatment-related dermatologic toxicities in the 30-month study was more than $337,409, or $2,576 per patient, Dr. Judy H. Borovicka reported at the annual meeting of the American Academy of Dermatology.
The analysis included the cost of clinic visits, laboratory tests, diagnostic and therapeutic procedures, medications, and supplies, said Dr. Borovicka, a clinical trial investigator at Northwestern University, Chicago.
Patients had a total of 481 visits (for an average of 3.7 per person) to a subspecialty clinic developed to treat skin and eye reactions to inhibitors of epidermal growth-factor receptor and kinases (the SERIES Clinic in Chicago) between November 2005 and April 2008, for a mean cost per visit of $701. All were diagnosed with 1 of 15 primary cancer types, and were treated with rituximab, erlotinib, imatinib, lapatinib, panitumumab, sorafenib, or sunitinib.
The more common dermatologic toxicities associated with these drugs included papulopustular rash, periungual inflammation, xerosis, alopecia, and ocular changes. Papulopustular rash was the most common toxicity, occurring in 45%-100% of patients.
Sorafenib induced the most costly dermatologic toxicities, with a mean overall patient cost of $2,974; lapatinib and imatinib were associated with the least costly toxicities, with mean overall costs of $1,275 and $1,490, respectively, Dr. Borovicka said, noting that the differences in cost between sorafenib and lapatinib/imatinib were statistically significant.
Toxicity severity was predictive of increased patient cost; however, age, gender, race/ethnicity, cancer type, and cancer severity were not predictors of patient cost, Dr. Borovicka said.
"Toxicities impact the quality of life of patients undergoing treatment with targeted anticancer therapies, and they carry significant financial implications... management of untoward effects is paramount to minimizing the disruption of therapy," she concluded.
Dr. Borovicka stated that she has no relevant financial or other disclosures related to this study.
ACGME Releases Revised Requirements for Procedural Derm Fellows
Procedural dermatology fellows will soon have new requirements, including specifics about how many surgical cases they must perform.
The requirement is one of the changes put forward by the Accreditation Council for Graduate Medical Education as part of a regular review of the graduate medical education program requirements for procedural dermatology. This is the first revision to the program requirements since the subspecialty was first accredited in 2003.
The new requirements are scheduled to go into effect in July, but there may be some additional revisions before then as the group receives last-minute comments on the document, according to ACGME. The current requirements and revisions are posted online at www.acgme.org/acWebsite/RRC_080/080_prIndex.asp.
Under the revised document, ACGME is keeping the requirement that fellowship programs provide a sufficient volume and variety of surgical cases for fellows, specifically that at least 1,000 dermatologic surgical procedures per fellow are available and that at least 500 of that total must be Mohs micrographic surgery procedures. ACGME, however, is now also specifying case requirements for individual fellows. Fellows must perform, not simply observe, at least 400 surgical cases, of which at least 200 have to be Mohs surgery procedures.
ACGME is also adding requirements that frozen section slides for Mohs surgery must be reviewed and approved as part of an ongoing quality assurance program by an appropriate peer-reviewed organization. Facilities also will be required to have their frozen section laboratory and examination areas accredited by appropriate oversight bodies.
The biggest change in the document is the way it is organized, but much of the content is the same, said Dr. Randall K. Roenigk, professor of dermatology at the Mayo Clinic in Rochester, Minn., and chair of ACGME's Residency Review Committee for Dermatology. For example, the three major components of procedural dermatology fellowship training--Mohs micrographic surgery, reconstruction, and cosmetic surgery--remain the same, he said.
The regular revisions to the program requirements by ACGME are really a way to assure the public. "It's really an attempt to demonstrate to the public that we're doing our best to train the best doctors," Dr. Roenigk said.
But Dr. Lee S. Portnoff, a full-time Mohs surgeon in St. Louis and president of the American Society for Mohs Surgery, said that he is concerned about some of the changes ACGME has made.
The requirement to perform at least 400 surgical cases, of which at least 200 are Mohs procedures, would allow some fellows to complete the requirements without getting sufficient experience in non-Mohs surgeries, he said. If fellows are allowed to count Mohs-related repairs toward their overall surgical requirement, they could easily meet the requirements without doing much in the way of other types of procedures.
"This may be just a Mohs fellowship by another name," Dr. Portnoff said.
Procedural dermatology fellows will soon have new requirements, including specifics about how many surgical cases they must perform.
The requirement is one of the changes put forward by the Accreditation Council for Graduate Medical Education as part of a regular review of the graduate medical education program requirements for procedural dermatology. This is the first revision to the program requirements since the subspecialty was first accredited in 2003.
The new requirements are scheduled to go into effect in July, but there may be some additional revisions before then as the group receives last-minute comments on the document, according to ACGME. The current requirements and revisions are posted online at www.acgme.org/acWebsite/RRC_080/080_prIndex.asp.
Under the revised document, ACGME is keeping the requirement that fellowship programs provide a sufficient volume and variety of surgical cases for fellows, specifically that at least 1,000 dermatologic surgical procedures per fellow are available and that at least 500 of that total must be Mohs micrographic surgery procedures. ACGME, however, is now also specifying case requirements for individual fellows. Fellows must perform, not simply observe, at least 400 surgical cases, of which at least 200 have to be Mohs surgery procedures.
ACGME is also adding requirements that frozen section slides for Mohs surgery must be reviewed and approved as part of an ongoing quality assurance program by an appropriate peer-reviewed organization. Facilities also will be required to have their frozen section laboratory and examination areas accredited by appropriate oversight bodies.
The biggest change in the document is the way it is organized, but much of the content is the same, said Dr. Randall K. Roenigk, professor of dermatology at the Mayo Clinic in Rochester, Minn., and chair of ACGME's Residency Review Committee for Dermatology. For example, the three major components of procedural dermatology fellowship training--Mohs micrographic surgery, reconstruction, and cosmetic surgery--remain the same, he said.
The regular revisions to the program requirements by ACGME are really a way to assure the public. "It's really an attempt to demonstrate to the public that we're doing our best to train the best doctors," Dr. Roenigk said.
But Dr. Lee S. Portnoff, a full-time Mohs surgeon in St. Louis and president of the American Society for Mohs Surgery, said that he is concerned about some of the changes ACGME has made.
The requirement to perform at least 400 surgical cases, of which at least 200 are Mohs procedures, would allow some fellows to complete the requirements without getting sufficient experience in non-Mohs surgeries, he said. If fellows are allowed to count Mohs-related repairs toward their overall surgical requirement, they could easily meet the requirements without doing much in the way of other types of procedures.
"This may be just a Mohs fellowship by another name," Dr. Portnoff said.
Procedural dermatology fellows will soon have new requirements, including specifics about how many surgical cases they must perform.
The requirement is one of the changes put forward by the Accreditation Council for Graduate Medical Education as part of a regular review of the graduate medical education program requirements for procedural dermatology. This is the first revision to the program requirements since the subspecialty was first accredited in 2003.
The new requirements are scheduled to go into effect in July, but there may be some additional revisions before then as the group receives last-minute comments on the document, according to ACGME. The current requirements and revisions are posted online at www.acgme.org/acWebsite/RRC_080/080_prIndex.asp.
Under the revised document, ACGME is keeping the requirement that fellowship programs provide a sufficient volume and variety of surgical cases for fellows, specifically that at least 1,000 dermatologic surgical procedures per fellow are available and that at least 500 of that total must be Mohs micrographic surgery procedures. ACGME, however, is now also specifying case requirements for individual fellows. Fellows must perform, not simply observe, at least 400 surgical cases, of which at least 200 have to be Mohs surgery procedures.
ACGME is also adding requirements that frozen section slides for Mohs surgery must be reviewed and approved as part of an ongoing quality assurance program by an appropriate peer-reviewed organization. Facilities also will be required to have their frozen section laboratory and examination areas accredited by appropriate oversight bodies.
The biggest change in the document is the way it is organized, but much of the content is the same, said Dr. Randall K. Roenigk, professor of dermatology at the Mayo Clinic in Rochester, Minn., and chair of ACGME's Residency Review Committee for Dermatology. For example, the three major components of procedural dermatology fellowship training--Mohs micrographic surgery, reconstruction, and cosmetic surgery--remain the same, he said.
The regular revisions to the program requirements by ACGME are really a way to assure the public. "It's really an attempt to demonstrate to the public that we're doing our best to train the best doctors," Dr. Roenigk said.
But Dr. Lee S. Portnoff, a full-time Mohs surgeon in St. Louis and president of the American Society for Mohs Surgery, said that he is concerned about some of the changes ACGME has made.
The requirement to perform at least 400 surgical cases, of which at least 200 are Mohs procedures, would allow some fellows to complete the requirements without getting sufficient experience in non-Mohs surgeries, he said. If fellows are allowed to count Mohs-related repairs toward their overall surgical requirement, they could easily meet the requirements without doing much in the way of other types of procedures.
"This may be just a Mohs fellowship by another name," Dr. Portnoff said.