Melanoma

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

"The most striking differences in melanoma incidence and mortality occur in the elderly," wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed. The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color.

In the physical examination, the investigators recorded number of melano-cytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

"Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population," wrote the authors, who also put the number of lifetime severe sunburns in this category. "On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients" aged 60 or older.

In addition to chronic sun exposure and smoking, lifetime severe sunburns, blond or red hair, the number of melanocytic nevi, and personal history were statistically significant in the multivariate analyses, whereas solar lentigines and actinic keratoses and intermittent sun exposure were not.

The authors emphasized the importance of these findings in the context of a progressively aging population. However, they cited their use of self-reported data, selection bias, and small sample size as limitations of the study and said that further studies are needed.

None of the authors disclosed any conflicts of interest.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

"The most striking differences in melanoma incidence and mortality occur in the elderly," wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed. The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color.

In the physical examination, the investigators recorded number of melano-cytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

"Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population," wrote the authors, who also put the number of lifetime severe sunburns in this category. "On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients" aged 60 or older.

In addition to chronic sun exposure and smoking, lifetime severe sunburns, blond or red hair, the number of melanocytic nevi, and personal history were statistically significant in the multivariate analyses, whereas solar lentigines and actinic keratoses and intermittent sun exposure were not.

The authors emphasized the importance of these findings in the context of a progressively aging population. However, they cited their use of self-reported data, selection bias, and small sample size as limitations of the study and said that further studies are needed.

None of the authors disclosed any conflicts of interest.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

"The most striking differences in melanoma incidence and mortality occur in the elderly," wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed. The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color.

In the physical examination, the investigators recorded number of melano-cytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

"Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population," wrote the authors, who also put the number of lifetime severe sunburns in this category. "On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients" aged 60 or older.

In addition to chronic sun exposure and smoking, lifetime severe sunburns, blond or red hair, the number of melanocytic nevi, and personal history were statistically significant in the multivariate analyses, whereas solar lentigines and actinic keratoses and intermittent sun exposure were not.

The authors emphasized the importance of these findings in the context of a progressively aging population. However, they cited their use of self-reported data, selection bias, and small sample size as limitations of the study and said that further studies are needed.

None of the authors disclosed any conflicts of interest.

ORLANDO — Fewer than half of childhood cancer survivors who are deemed to be at high risk of secondary breast, colon, and skin malignancies follow cancer-screening and surveillance recommendations as adults, according to a new analysis of the large, longitudinal Childhood Cancer Survivors Study.

Skin cancer is the most common radiation-associated second malignancy in survivors, but just 26.7% of 4,833 survivors at high risk had ever had a complete skin exam, said Dr. Paul Nathan, an oncologist at the Hospital for Sick Children in Toronto.

High-risk survivors were the least compliant with colonoscopy recommendations: Only 11.5% of 794 survivors who were considered vulnerable for colorectal cancer had a colonoscopy during the 5 years before they were surveyed, Dr. Nathan reported at the annual meeting of the American Society of Clinical Oncology.

Women at high risk for breast cancer were more compliant with recommendations, he added; even so, only 46.3% of 521 in this group had a mammogram performed during the 2 years before they were asked about screening.

Most of the 8,318 survivors surveyed in this phase of the National Cancer Institute-funded study were in the care of family physicians. About 12.5% had been seen at a cancer center or within a long-term follow-up program in the previous 2 years. Another 12% reported no medical care during this time. The remaining patients were "predominantly seen by their primary care physician in their community," he said.

Cancer survivors and their primary care physicians need to be more vigilant, Dr. Nathan said. Individual primary care physicians may have only a few childhood cancer survivors in their practice, he said, but they should be made aware of these patients' special requirements.

"There is broad consensus that survivors of childhood cancer need regular surveillance and screening in the hope that if we pick up these cancers early, we can change the mortality [and morbidity]," Dr. Nathan said.

Study discussant Dr. Charles L. Bennett, professor of geriatrics, economics, and oncology at Northwestern University, Chicago, was unsure whether survivorship care was the responsibility of oncologists or primary care providers but suggested it is most likely a shared responsibility.

This study is important because "surveillance is essential, yet empirical data are lacking," Dr. Bennett said, adding that "these are real issues. These are lifelong concerns."

With a 5-year survival rate of 80% for pediatric cancers, most patients survive long term (J. Clin. Oncol. 2009;27:2308-18). Dr. Nathan estimated that about 9% of 325,000 survivors of childhood cancer who are alive in the United States will develop a new malignancy within 30 years of their original diagnosis. In addition, secondary malignancies are the leading cause of death among survivors who live at least 20 years beyond initial diagnosis.

The Childhood Cancer Survivors Study enrolled 20,602 people who were initially diagnosed with cancer in 1970-1986 and had survived at least 5 years. Of these original participants, 3,305 had been lost to follow-up and 1,541 had died by the time of the 2003 follow-up survey, on which the new study is based. Another 3,197 declined to participate in the survey and 990 were excluded from the analysis (among them, 960 survivors who had already developed a secondary malignancy). The average age of survivors interviewed was 31.2 years. A matched group of 2,661 siblings and 8,318 population controls was also assessed.

The study's primary aim was to determine adherence to the Children's Oncology Group's guidelines for following survivors of childhood cancers. Survivors were considered at high risk for the following:

▸ Skin cancer, if they were exposed to any radiation during childhood. An annual skin examination of treated areas is recommended. ("We know the rate of nonmelanoma skin cancers in irradiated areas is approaching 7% for survivors over 30 years," Dr. Nathan noted.)

▸ Breast cancer, if they received 20 Gy or more of radiation therapy to the breast during childhood. Mammography is recommended every 1-2 years beginning at age 25 years, or 8 years after the initial cancer diagnosis for these patients.

▸ Colorectal cancer, if they received 30 Gy or more of radiation to the abdomen, pelvis, or spine. Screening colonoscopy is recommended every 5 years starting at age 35 years.

In a secondary analysis, the researchers compared survivors who were not at high risk of secondary cancers with matched controls from the National Health Interview Survey of the general population to determine adherence to U.S. Preventive Services Task Force cancer screening guidelines for breast, colon, and cervical cancer.

They found that these survivors were more likely to undergo recommended mammography (67%, vs. 58% of controls), were more compliant with Pap smear recommendations (82% vs. 70%), and had a comparable—albeit low—rate of recommended colonoscopy (24% in both groups).

Predictors of adherence to the skin examination were care at a cancer center (RR, 1.55) and the survivor's having a treatment summary (RR, 1.30). Being a nonwhite patient was associated with a lower likelihood of adherence to the skin examination guideline (RR, 0.63), he reported.

Significant predictors of adherence to mammography were older age at interview (RR, 1.09) and care at a cancer center (RR, 1.70).

Older age at the time of the interview was the only significant predictor of colonoscopy adherence (RR, 1.08).

The investigation was limited by the fact that the cancer diagnoses occurred from 1970 to 1986 "and clearly therapy has changed," Dr. Nathan said. Investigators are recruiting another 20,000 adult survivors who were treated as children between 1987 and 1999 to ask similar questions of a more contemporary cohort.

The new study population also will include more minorities. About 89% of survivors in the current study are white non-Hispanics.

As survivors of childhood cancer live longer, increasing attention is being paid to the long-term effects of therapy. A key question is whether changes at the time of therapy administration will have an impact on these downstream adverse effects. A consortium of institutions is planning intervention studies to address such questions and to see whether using innovative methods to educate patients about their follow-up needs will make a difference, Dr. Nathan added.

Dr. Nathan reported having no relevant conflicts of interests to disclose.

To view a video interview of Dr. Nathan, go to www.youtube.com/watch?v=aF7c1xCGpAY&feature=channel_page

Just 26.7% of the 4,833 skin cancer survivors at high risk had ever had a complete skin exam.

Source DR. NATHAN

ORLANDO — Fewer than half of childhood cancer survivors who are deemed to be at high risk of secondary breast, colon, and skin malignancies follow cancer-screening and surveillance recommendations as adults, according to a new analysis of the large, longitudinal Childhood Cancer Survivors Study.

Skin cancer is the most common radiation-associated second malignancy in survivors, but just 26.7% of 4,833 survivors at high risk had ever had a complete skin exam, said Dr. Paul Nathan, an oncologist at the Hospital for Sick Children in Toronto.

High-risk survivors were the least compliant with colonoscopy recommendations: Only 11.5% of 794 survivors who were considered vulnerable for colorectal cancer had a colonoscopy during the 5 years before they were surveyed, Dr. Nathan reported at the annual meeting of the American Society of Clinical Oncology.

Women at high risk for breast cancer were more compliant with recommendations, he added; even so, only 46.3% of 521 in this group had a mammogram performed during the 2 years before they were asked about screening.

Most of the 8,318 survivors surveyed in this phase of the National Cancer Institute-funded study were in the care of family physicians. About 12.5% had been seen at a cancer center or within a long-term follow-up program in the previous 2 years. Another 12% reported no medical care during this time. The remaining patients were "predominantly seen by their primary care physician in their community," he said.

Cancer survivors and their primary care physicians need to be more vigilant, Dr. Nathan said. Individual primary care physicians may have only a few childhood cancer survivors in their practice, he said, but they should be made aware of these patients' special requirements.

"There is broad consensus that survivors of childhood cancer need regular surveillance and screening in the hope that if we pick up these cancers early, we can change the mortality [and morbidity]," Dr. Nathan said.

Study discussant Dr. Charles L. Bennett, professor of geriatrics, economics, and oncology at Northwestern University, Chicago, was unsure whether survivorship care was the responsibility of oncologists or primary care providers but suggested it is most likely a shared responsibility.

This study is important because "surveillance is essential, yet empirical data are lacking," Dr. Bennett said, adding that "these are real issues. These are lifelong concerns."

With a 5-year survival rate of 80% for pediatric cancers, most patients survive long term (J. Clin. Oncol. 2009;27:2308-18). Dr. Nathan estimated that about 9% of 325,000 survivors of childhood cancer who are alive in the United States will develop a new malignancy within 30 years of their original diagnosis. In addition, secondary malignancies are the leading cause of death among survivors who live at least 20 years beyond initial diagnosis.

The Childhood Cancer Survivors Study enrolled 20,602 people who were initially diagnosed with cancer in 1970-1986 and had survived at least 5 years. Of these original participants, 3,305 had been lost to follow-up and 1,541 had died by the time of the 2003 follow-up survey, on which the new study is based. Another 3,197 declined to participate in the survey and 990 were excluded from the analysis (among them, 960 survivors who had already developed a secondary malignancy). The average age of survivors interviewed was 31.2 years. A matched group of 2,661 siblings and 8,318 population controls was also assessed.

The study's primary aim was to determine adherence to the Children's Oncology Group's guidelines for following survivors of childhood cancers. Survivors were considered at high risk for the following:

▸ Skin cancer, if they were exposed to any radiation during childhood. An annual skin examination of treated areas is recommended. ("We know the rate of nonmelanoma skin cancers in irradiated areas is approaching 7% for survivors over 30 years," Dr. Nathan noted.)

▸ Breast cancer, if they received 20 Gy or more of radiation therapy to the breast during childhood. Mammography is recommended every 1-2 years beginning at age 25 years, or 8 years after the initial cancer diagnosis for these patients.

▸ Colorectal cancer, if they received 30 Gy or more of radiation to the abdomen, pelvis, or spine. Screening colonoscopy is recommended every 5 years starting at age 35 years.

In a secondary analysis, the researchers compared survivors who were not at high risk of secondary cancers with matched controls from the National Health Interview Survey of the general population to determine adherence to U.S. Preventive Services Task Force cancer screening guidelines for breast, colon, and cervical cancer.

They found that these survivors were more likely to undergo recommended mammography (67%, vs. 58% of controls), were more compliant with Pap smear recommendations (82% vs. 70%), and had a comparable—albeit low—rate of recommended colonoscopy (24% in both groups).

Predictors of adherence to the skin examination were care at a cancer center (RR, 1.55) and the survivor's having a treatment summary (RR, 1.30). Being a nonwhite patient was associated with a lower likelihood of adherence to the skin examination guideline (RR, 0.63), he reported.

Significant predictors of adherence to mammography were older age at interview (RR, 1.09) and care at a cancer center (RR, 1.70).

Older age at the time of the interview was the only significant predictor of colonoscopy adherence (RR, 1.08).

The investigation was limited by the fact that the cancer diagnoses occurred from 1970 to 1986 "and clearly therapy has changed," Dr. Nathan said. Investigators are recruiting another 20,000 adult survivors who were treated as children between 1987 and 1999 to ask similar questions of a more contemporary cohort.

The new study population also will include more minorities. About 89% of survivors in the current study are white non-Hispanics.

As survivors of childhood cancer live longer, increasing attention is being paid to the long-term effects of therapy. A key question is whether changes at the time of therapy administration will have an impact on these downstream adverse effects. A consortium of institutions is planning intervention studies to address such questions and to see whether using innovative methods to educate patients about their follow-up needs will make a difference, Dr. Nathan added.

Dr. Nathan reported having no relevant conflicts of interests to disclose.

To view a video interview of Dr. Nathan, go to www.youtube.com/watch?v=aF7c1xCGpAY&feature=channel_page

Just 26.7% of the 4,833 skin cancer survivors at high risk had ever had a complete skin exam.

Source DR. NATHAN

ORLANDO — Fewer than half of childhood cancer survivors who are deemed to be at high risk of secondary breast, colon, and skin malignancies follow cancer-screening and surveillance recommendations as adults, according to a new analysis of the large, longitudinal Childhood Cancer Survivors Study.

Skin cancer is the most common radiation-associated second malignancy in survivors, but just 26.7% of 4,833 survivors at high risk had ever had a complete skin exam, said Dr. Paul Nathan, an oncologist at the Hospital for Sick Children in Toronto.

High-risk survivors were the least compliant with colonoscopy recommendations: Only 11.5% of 794 survivors who were considered vulnerable for colorectal cancer had a colonoscopy during the 5 years before they were surveyed, Dr. Nathan reported at the annual meeting of the American Society of Clinical Oncology.

Women at high risk for breast cancer were more compliant with recommendations, he added; even so, only 46.3% of 521 in this group had a mammogram performed during the 2 years before they were asked about screening.

Most of the 8,318 survivors surveyed in this phase of the National Cancer Institute-funded study were in the care of family physicians. About 12.5% had been seen at a cancer center or within a long-term follow-up program in the previous 2 years. Another 12% reported no medical care during this time. The remaining patients were "predominantly seen by their primary care physician in their community," he said.

Cancer survivors and their primary care physicians need to be more vigilant, Dr. Nathan said. Individual primary care physicians may have only a few childhood cancer survivors in their practice, he said, but they should be made aware of these patients' special requirements.

"There is broad consensus that survivors of childhood cancer need regular surveillance and screening in the hope that if we pick up these cancers early, we can change the mortality [and morbidity]," Dr. Nathan said.

Study discussant Dr. Charles L. Bennett, professor of geriatrics, economics, and oncology at Northwestern University, Chicago, was unsure whether survivorship care was the responsibility of oncologists or primary care providers but suggested it is most likely a shared responsibility.

This study is important because "surveillance is essential, yet empirical data are lacking," Dr. Bennett said, adding that "these are real issues. These are lifelong concerns."

With a 5-year survival rate of 80% for pediatric cancers, most patients survive long term (J. Clin. Oncol. 2009;27:2308-18). Dr. Nathan estimated that about 9% of 325,000 survivors of childhood cancer who are alive in the United States will develop a new malignancy within 30 years of their original diagnosis. In addition, secondary malignancies are the leading cause of death among survivors who live at least 20 years beyond initial diagnosis.

The Childhood Cancer Survivors Study enrolled 20,602 people who were initially diagnosed with cancer in 1970-1986 and had survived at least 5 years. Of these original participants, 3,305 had been lost to follow-up and 1,541 had died by the time of the 2003 follow-up survey, on which the new study is based. Another 3,197 declined to participate in the survey and 990 were excluded from the analysis (among them, 960 survivors who had already developed a secondary malignancy). The average age of survivors interviewed was 31.2 years. A matched group of 2,661 siblings and 8,318 population controls was also assessed.

The study's primary aim was to determine adherence to the Children's Oncology Group's guidelines for following survivors of childhood cancers. Survivors were considered at high risk for the following:

▸ Skin cancer, if they were exposed to any radiation during childhood. An annual skin examination of treated areas is recommended. ("We know the rate of nonmelanoma skin cancers in irradiated areas is approaching 7% for survivors over 30 years," Dr. Nathan noted.)

▸ Breast cancer, if they received 20 Gy or more of radiation therapy to the breast during childhood. Mammography is recommended every 1-2 years beginning at age 25 years, or 8 years after the initial cancer diagnosis for these patients.

▸ Colorectal cancer, if they received 30 Gy or more of radiation to the abdomen, pelvis, or spine. Screening colonoscopy is recommended every 5 years starting at age 35 years.

In a secondary analysis, the researchers compared survivors who were not at high risk of secondary cancers with matched controls from the National Health Interview Survey of the general population to determine adherence to U.S. Preventive Services Task Force cancer screening guidelines for breast, colon, and cervical cancer.

They found that these survivors were more likely to undergo recommended mammography (67%, vs. 58% of controls), were more compliant with Pap smear recommendations (82% vs. 70%), and had a comparable—albeit low—rate of recommended colonoscopy (24% in both groups).

Predictors of adherence to the skin examination were care at a cancer center (RR, 1.55) and the survivor's having a treatment summary (RR, 1.30). Being a nonwhite patient was associated with a lower likelihood of adherence to the skin examination guideline (RR, 0.63), he reported.

Significant predictors of adherence to mammography were older age at interview (RR, 1.09) and care at a cancer center (RR, 1.70).

Older age at the time of the interview was the only significant predictor of colonoscopy adherence (RR, 1.08).

The investigation was limited by the fact that the cancer diagnoses occurred from 1970 to 1986 "and clearly therapy has changed," Dr. Nathan said. Investigators are recruiting another 20,000 adult survivors who were treated as children between 1987 and 1999 to ask similar questions of a more contemporary cohort.

The new study population also will include more minorities. About 89% of survivors in the current study are white non-Hispanics.

As survivors of childhood cancer live longer, increasing attention is being paid to the long-term effects of therapy. A key question is whether changes at the time of therapy administration will have an impact on these downstream adverse effects. A consortium of institutions is planning intervention studies to address such questions and to see whether using innovative methods to educate patients about their follow-up needs will make a difference, Dr. Nathan added.

Dr. Nathan reported having no relevant conflicts of interests to disclose.

To view a video interview of Dr. Nathan, go to www.youtube.com/watch?v=aF7c1xCGpAY&feature=channel_page

Just 26.7% of the 4,833 skin cancer survivors at high risk had ever had a complete skin exam.

Source DR. NATHAN

AUSTIN, TEX. — Getting good, consistent pre- and postoperative photos of Mohs procedures is crucial to documenting a reconstructive procedure and sharing those procedures and outcomes with colleagues.

Dr. Juan-Carlos Martinez of the Mayo Clinic in Jacksonville, Fla., shared tips on getting the best pictures at the annual meeting of the American College of Mohs Surgery. "Mohs surgeons make a living out of striving for perfection," he said, adding that "photographs can and should reflect those same qualities," including being meticulous, thoughtful, and consistent.

Consistency, especially, is key. Ideally, the only difference between the preoperative and postoperative photos should be the surgical intervention, said Dr. Martinez.

The standard for photography is to have a dedicated studio, but this is an expensive undertaking. Although photographs might not turn out as well without such a studio, the advent of digital photography has simplified image acquisition and management, making it much easier to obtain high-quality, reproducible photographs, he said. There are some simple tools that can make this task easier: a felt-covered foam board for a background and a digital camera with at least 7 megapixels of resolution. The felt board can be purchased online or made from materials obtained at a local hardware store. The camera can be a digital single lens reflex (SLR) or a point-and-shoot model.

The same camera should always be used. It's also important to always use flash to maintain consistent lighting.

To frame the photos and keep up the consistency, use anatomic landmarks. The patient should always be sitting upright, in front of the felt board, looking straight ahead. A neutral expression is best, since smiles are hard to reproduce on a consistent basis. Gently closed eyes can help avoid the distraction of inconsistent sideways glances, said Dr. Martinez.

Some cameras have a viewfinder grid, which allows better framing. Dr. Martinez uses a horizontal line across the pupils to ensure there is symmetric framing for the frontal, oblique, and base views. For an oblique view, he uses the same horizontal line across the pupils and another across the peak of the nasal tip. This locks the head in the transverse and sagittal planes. For a lateral image, he employs a single horizontal line from the lateral canthus to the top of the auricular helix and a vertical line from the brow to the chin. The goal is to ensure that no aspect of the contralateral brow is in view.

The base view is preferred by professional photographers, said Dr. Martinez, noting that it's nicknamed the "view of shame" because it will highlight the slightest tip or alar distortion resulting from a reconstruction. It is useful for any tumor on or near the nose. Any nasal reconstructive paper or presentation should include this view.

Dr. Martinez reported no conflicts.

AUSTIN, TEX. — Getting good, consistent pre- and postoperative photos of Mohs procedures is crucial to documenting a reconstructive procedure and sharing those procedures and outcomes with colleagues.

Dr. Juan-Carlos Martinez of the Mayo Clinic in Jacksonville, Fla., shared tips on getting the best pictures at the annual meeting of the American College of Mohs Surgery. "Mohs surgeons make a living out of striving for perfection," he said, adding that "photographs can and should reflect those same qualities," including being meticulous, thoughtful, and consistent.

Consistency, especially, is key. Ideally, the only difference between the preoperative and postoperative photos should be the surgical intervention, said Dr. Martinez.

The standard for photography is to have a dedicated studio, but this is an expensive undertaking. Although photographs might not turn out as well without such a studio, the advent of digital photography has simplified image acquisition and management, making it much easier to obtain high-quality, reproducible photographs, he said. There are some simple tools that can make this task easier: a felt-covered foam board for a background and a digital camera with at least 7 megapixels of resolution. The felt board can be purchased online or made from materials obtained at a local hardware store. The camera can be a digital single lens reflex (SLR) or a point-and-shoot model.

The same camera should always be used. It's also important to always use flash to maintain consistent lighting.

To frame the photos and keep up the consistency, use anatomic landmarks. The patient should always be sitting upright, in front of the felt board, looking straight ahead. A neutral expression is best, since smiles are hard to reproduce on a consistent basis. Gently closed eyes can help avoid the distraction of inconsistent sideways glances, said Dr. Martinez.

Some cameras have a viewfinder grid, which allows better framing. Dr. Martinez uses a horizontal line across the pupils to ensure there is symmetric framing for the frontal, oblique, and base views. For an oblique view, he uses the same horizontal line across the pupils and another across the peak of the nasal tip. This locks the head in the transverse and sagittal planes. For a lateral image, he employs a single horizontal line from the lateral canthus to the top of the auricular helix and a vertical line from the brow to the chin. The goal is to ensure that no aspect of the contralateral brow is in view.

The base view is preferred by professional photographers, said Dr. Martinez, noting that it's nicknamed the "view of shame" because it will highlight the slightest tip or alar distortion resulting from a reconstruction. It is useful for any tumor on or near the nose. Any nasal reconstructive paper or presentation should include this view.

Dr. Martinez reported no conflicts.

AUSTIN, TEX. — Getting good, consistent pre- and postoperative photos of Mohs procedures is crucial to documenting a reconstructive procedure and sharing those procedures and outcomes with colleagues.

Dr. Juan-Carlos Martinez of the Mayo Clinic in Jacksonville, Fla., shared tips on getting the best pictures at the annual meeting of the American College of Mohs Surgery. "Mohs surgeons make a living out of striving for perfection," he said, adding that "photographs can and should reflect those same qualities," including being meticulous, thoughtful, and consistent.

Consistency, especially, is key. Ideally, the only difference between the preoperative and postoperative photos should be the surgical intervention, said Dr. Martinez.

The standard for photography is to have a dedicated studio, but this is an expensive undertaking. Although photographs might not turn out as well without such a studio, the advent of digital photography has simplified image acquisition and management, making it much easier to obtain high-quality, reproducible photographs, he said. There are some simple tools that can make this task easier: a felt-covered foam board for a background and a digital camera with at least 7 megapixels of resolution. The felt board can be purchased online or made from materials obtained at a local hardware store. The camera can be a digital single lens reflex (SLR) or a point-and-shoot model.

The same camera should always be used. It's also important to always use flash to maintain consistent lighting.

To frame the photos and keep up the consistency, use anatomic landmarks. The patient should always be sitting upright, in front of the felt board, looking straight ahead. A neutral expression is best, since smiles are hard to reproduce on a consistent basis. Gently closed eyes can help avoid the distraction of inconsistent sideways glances, said Dr. Martinez.

Some cameras have a viewfinder grid, which allows better framing. Dr. Martinez uses a horizontal line across the pupils to ensure there is symmetric framing for the frontal, oblique, and base views. For an oblique view, he uses the same horizontal line across the pupils and another across the peak of the nasal tip. This locks the head in the transverse and sagittal planes. For a lateral image, he employs a single horizontal line from the lateral canthus to the top of the auricular helix and a vertical line from the brow to the chin. The goal is to ensure that no aspect of the contralateral brow is in view.

The base view is preferred by professional photographers, said Dr. Martinez, noting that it's nicknamed the "view of shame" because it will highlight the slightest tip or alar distortion resulting from a reconstruction. It is useful for any tumor on or near the nose. Any nasal reconstructive paper or presentation should include this view.

Dr. Martinez reported no conflicts.

Saffron (Crocus sativus), a member of the Iridaceae family, is native to Southwest Asia, particularly Iran, but was first cultivated in Greece. It has been used as a spice or food flavoring agent, as well as a fragrance, clothing dye, and medicine, for 3,000 years. Saffron also was used for various medical indications by the ancient Persians and Egyptians, and later by the medieval Europeans (Exp. Biol. Med. 2002;227:20-5).

The traditional uses of saffron are borne out in modern medicine, as this botanical product continues to be known for its antispasmodic, carminative, diaphoretic, emmenagogic, and sedative properties (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]). Significantly, pharmacologic studies have shown that saffron has other salubrious benefits, including antioxidant, antimutagenic, and immunomodulatory activities (Asian Pac. J. Cancer Prev. 2004;5:70-6). Much recent research has focused on these properties, as well as on evidence that the spice exhibits anticarcinogenic activity (Exp. Biol. Med. 2002;227:20-5). This column will briefly review the primary investigations of saffron that may potentially lay the groundwork for dermatologic applications.

Anticarcinogenic Actions

In 2004, Das et al. assessed the effects of an aqueous infusion of saffron on a two-stage skin papillogenesis/carcinogenesis mouse model, using 7,12-dimethyl benz[a]anthracin (DMBA) to initiate, and croton oil to promote, tumor formation. Saffron application was found to significantly decrease papilloma development during the pre- and postinitiation periods, especially when the saffron was administered during both periods. The authors attributed the inhibitory effects of saffron, at least in part, to the modulatory effects of C. sativus on phase II detoxifying enzymes, such as glutathione S-transferase, glutathione peroxidase, and superoxide dismutase (Asian Pac. J. Cancer Prev. 2004;5:70-6).

Early in 2009, Das et al. utilized a histopathologic approach to evaluate the chemopreventive effect of aqueous saffron on chemically induced skin carcinogenesis in mice. Animals were divided into five groups: three saffron-treated groups, a carcinogen control group, and a normal control group. Twice a week for 8 weeks, the carcinogen control and saffron groups were administered three topical applications of DMBA followed by croton oil on shaven dorsal skin. Only topical applications of the vehicle (acetone) were given to normal controls. The three saffron groups were orally fed with saffron infusions either before (group A), after (group C), or both before and after (group B) the application of DMBA.

Standard histologic examination revealed that the skin benefited from saffron treatments administered both before and after chemically induced skin carcinogenesis. Specifically, the saffron-fed groups exhibited inhibition of papilloma formation, as well as reductions in the size of papillomas that did form, compared with the control groups. The authors concluded that early treatment with saffron suppresses DMBA-induced skin carcinoma in mice, at least partly because of activation of cellular defense systems, namely cellular antioxidant enzymes (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]).

The anticarcinogenic properties of saffron were also demonstrated in much earlier studies. In 1991, Salomi et al. found that topical application of extracts of the common food spices Nigella sativa and C. sativus suppressed skin carcinogenesis initiation and promotion in a mouse model also using DMBA and croton oil. Specifically, they observed a delay in the formation of papillomas and a lower mean number of papillomas per mouse with application of a 100-mg/kg body weight dose of the extracts. They also evaluated the effects of the extracts on 20-methylcholanthrene (MCA)-induced soft tissue sarcomas in albino mice. Whereas tumor incidence was 100% in MCA-treated control mice, intraperitoneal administration of N. sativa and oral administration of C. sativus (both at 100 mg/kg body weight) 30 days after subcutaneous administration of MCA (745 nmol/day for 2 days) yielded tumor incidences of 33.3% and 10%, respectively (Nutr. Cancer 1991;16:67-72).

That same year, some of the same researchers, led by Nair, studied the antitumor activity of saffron extract against intraperitoneally transplanted sarcoma-180 (S-180), Ehrlich ascites carcinoma (EAC), and Dalton's lymphoma ascites (DLA) tumors in mice. The life spans of S-180, EAC, and DLA mice were increased respectively by 110.0%, 83.5%, and 112.5%, respectively, compared with baseline life spans, as a result of the oral administration of 200 mg/kg body weight of the saffron extract. In vitro, the extract was cytotoxic to S-180, EAC, DLA, and P38B tumor cells. The authors concluded that these results suggest the potential for saffron as an anticancer agent (Cancer Lett. 1991;57:109-14).

Speed Burn Healing

In a recent study of the potential role of saffron in wound healing, investigators compared the treatment of heat-induced burn wounds in rats using saffron pollen extract and silver sulfadiazine. Hot water was used to generate the wound. Rats were divided into four groups and treated with a topical cream control, base, saffron (20%), or silver sulfadiazine (1%) 24 hours after the induced injury.

Researchers measured wound size on day 25 and determined the average wound area to be 5.5, 4.1, 4, and 0.9 cm

Bioactive Components

In 2004, Giaccio evaluated the known constituents of saffron as well as its characteristics (e.g., antitoxic effects, hormonelike effects, and anticarcinogenic properties). Crocetin (8,8'-diapo-8,8'-carotenoic acid), a carotenoid and one of the main active ingredients in saffron, was of particular focus. This carotenoid is known to enhance oxygen's capacity to diffuse through liquids, including plasma, and has been shown to increase alveolar transport and cerebral and pulmonary oxygenation. Notably, crocetin also suppresses skin tumor promotion in mice and exhibits other anticarcinogenic properties, which are typically ascribed to its antioxidant activity. Although Giaccio highlighted the significant properties of a key constituent of saffron, the author acknowledged that the promising results associated with crocetin have been identified in vitro or in laboratory animals, but not in humans (Crit. Rev. Food Sci. Nutr. 2004;44:155-72).

In 2005, Assimopoulou et al. reported on a C. sativus extract (including crocin and safranal, two bioactive components). They found that a methanol extract of saffron demonstrated significant antioxidant activity against the 1,1-diphenyl-2-picrylhydrazyl radical. Crocin exhibited greater radical scavenging activity than safranal, but the scavenging capacity of the latter compound was still noted to be high. The investigators concluded that saffron has the potential for functional uses in foods, beverages touted for antioxidant activity, and medical purposes, namely in pharmaceutic and cosmetic formulations intended to confer antioxidant and antiaging activity (Phytother. Res. 2005;19:997-1000).

Conclusion

Although saffron has a long history of traditional uses, it is no turmeric in terms of the body of modern research and evidence. Nevertheless, current scientific investigations appear to be promising, suggesting a significant potential for the contemporary uses of this spice in medical practice. The data supporting saffron's antioxidant properties and successful topical use in animal models are encouraging. That said, while saffron is used as an oral supplement and in Ayurvedic medicine, much more research is necessary to determine its efficacy and effectiveness in topical skin care.

Saffron (Crocus sativus), a member of the Iridaceae family, is native to Southwest Asia, particularly Iran, but was first cultivated in Greece. It has been used as a spice or food flavoring agent, as well as a fragrance, clothing dye, and medicine, for 3,000 years. Saffron also was used for various medical indications by the ancient Persians and Egyptians, and later by the medieval Europeans (Exp. Biol. Med. 2002;227:20-5).

The traditional uses of saffron are borne out in modern medicine, as this botanical product continues to be known for its antispasmodic, carminative, diaphoretic, emmenagogic, and sedative properties (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]). Significantly, pharmacologic studies have shown that saffron has other salubrious benefits, including antioxidant, antimutagenic, and immunomodulatory activities (Asian Pac. J. Cancer Prev. 2004;5:70-6). Much recent research has focused on these properties, as well as on evidence that the spice exhibits anticarcinogenic activity (Exp. Biol. Med. 2002;227:20-5). This column will briefly review the primary investigations of saffron that may potentially lay the groundwork for dermatologic applications.

Anticarcinogenic Actions

In 2004, Das et al. assessed the effects of an aqueous infusion of saffron on a two-stage skin papillogenesis/carcinogenesis mouse model, using 7,12-dimethyl benz[a]anthracin (DMBA) to initiate, and croton oil to promote, tumor formation. Saffron application was found to significantly decrease papilloma development during the pre- and postinitiation periods, especially when the saffron was administered during both periods. The authors attributed the inhibitory effects of saffron, at least in part, to the modulatory effects of C. sativus on phase II detoxifying enzymes, such as glutathione S-transferase, glutathione peroxidase, and superoxide dismutase (Asian Pac. J. Cancer Prev. 2004;5:70-6).

Early in 2009, Das et al. utilized a histopathologic approach to evaluate the chemopreventive effect of aqueous saffron on chemically induced skin carcinogenesis in mice. Animals were divided into five groups: three saffron-treated groups, a carcinogen control group, and a normal control group. Twice a week for 8 weeks, the carcinogen control and saffron groups were administered three topical applications of DMBA followed by croton oil on shaven dorsal skin. Only topical applications of the vehicle (acetone) were given to normal controls. The three saffron groups were orally fed with saffron infusions either before (group A), after (group C), or both before and after (group B) the application of DMBA.

Standard histologic examination revealed that the skin benefited from saffron treatments administered both before and after chemically induced skin carcinogenesis. Specifically, the saffron-fed groups exhibited inhibition of papilloma formation, as well as reductions in the size of papillomas that did form, compared with the control groups. The authors concluded that early treatment with saffron suppresses DMBA-induced skin carcinoma in mice, at least partly because of activation of cellular defense systems, namely cellular antioxidant enzymes (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]).

The anticarcinogenic properties of saffron were also demonstrated in much earlier studies. In 1991, Salomi et al. found that topical application of extracts of the common food spices Nigella sativa and C. sativus suppressed skin carcinogenesis initiation and promotion in a mouse model also using DMBA and croton oil. Specifically, they observed a delay in the formation of papillomas and a lower mean number of papillomas per mouse with application of a 100-mg/kg body weight dose of the extracts. They also evaluated the effects of the extracts on 20-methylcholanthrene (MCA)-induced soft tissue sarcomas in albino mice. Whereas tumor incidence was 100% in MCA-treated control mice, intraperitoneal administration of N. sativa and oral administration of C. sativus (both at 100 mg/kg body weight) 30 days after subcutaneous administration of MCA (745 nmol/day for 2 days) yielded tumor incidences of 33.3% and 10%, respectively (Nutr. Cancer 1991;16:67-72).

That same year, some of the same researchers, led by Nair, studied the antitumor activity of saffron extract against intraperitoneally transplanted sarcoma-180 (S-180), Ehrlich ascites carcinoma (EAC), and Dalton's lymphoma ascites (DLA) tumors in mice. The life spans of S-180, EAC, and DLA mice were increased respectively by 110.0%, 83.5%, and 112.5%, respectively, compared with baseline life spans, as a result of the oral administration of 200 mg/kg body weight of the saffron extract. In vitro, the extract was cytotoxic to S-180, EAC, DLA, and P38B tumor cells. The authors concluded that these results suggest the potential for saffron as an anticancer agent (Cancer Lett. 1991;57:109-14).

Speed Burn Healing

In a recent study of the potential role of saffron in wound healing, investigators compared the treatment of heat-induced burn wounds in rats using saffron pollen extract and silver sulfadiazine. Hot water was used to generate the wound. Rats were divided into four groups and treated with a topical cream control, base, saffron (20%), or silver sulfadiazine (1%) 24 hours after the induced injury.

Researchers measured wound size on day 25 and determined the average wound area to be 5.5, 4.1, 4, and 0.9 cm

Bioactive Components

In 2004, Giaccio evaluated the known constituents of saffron as well as its characteristics (e.g., antitoxic effects, hormonelike effects, and anticarcinogenic properties). Crocetin (8,8'-diapo-8,8'-carotenoic acid), a carotenoid and one of the main active ingredients in saffron, was of particular focus. This carotenoid is known to enhance oxygen's capacity to diffuse through liquids, including plasma, and has been shown to increase alveolar transport and cerebral and pulmonary oxygenation. Notably, crocetin also suppresses skin tumor promotion in mice and exhibits other anticarcinogenic properties, which are typically ascribed to its antioxidant activity. Although Giaccio highlighted the significant properties of a key constituent of saffron, the author acknowledged that the promising results associated with crocetin have been identified in vitro or in laboratory animals, but not in humans (Crit. Rev. Food Sci. Nutr. 2004;44:155-72).

In 2005, Assimopoulou et al. reported on a C. sativus extract (including crocin and safranal, two bioactive components). They found that a methanol extract of saffron demonstrated significant antioxidant activity against the 1,1-diphenyl-2-picrylhydrazyl radical. Crocin exhibited greater radical scavenging activity than safranal, but the scavenging capacity of the latter compound was still noted to be high. The investigators concluded that saffron has the potential for functional uses in foods, beverages touted for antioxidant activity, and medical purposes, namely in pharmaceutic and cosmetic formulations intended to confer antioxidant and antiaging activity (Phytother. Res. 2005;19:997-1000).

Conclusion

Although saffron has a long history of traditional uses, it is no turmeric in terms of the body of modern research and evidence. Nevertheless, current scientific investigations appear to be promising, suggesting a significant potential for the contemporary uses of this spice in medical practice. The data supporting saffron's antioxidant properties and successful topical use in animal models are encouraging. That said, while saffron is used as an oral supplement and in Ayurvedic medicine, much more research is necessary to determine its efficacy and effectiveness in topical skin care.

Saffron (Crocus sativus), a member of the Iridaceae family, is native to Southwest Asia, particularly Iran, but was first cultivated in Greece. It has been used as a spice or food flavoring agent, as well as a fragrance, clothing dye, and medicine, for 3,000 years. Saffron also was used for various medical indications by the ancient Persians and Egyptians, and later by the medieval Europeans (Exp. Biol. Med. 2002;227:20-5).

The traditional uses of saffron are borne out in modern medicine, as this botanical product continues to be known for its antispasmodic, carminative, diaphoretic, emmenagogic, and sedative properties (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]). Significantly, pharmacologic studies have shown that saffron has other salubrious benefits, including antioxidant, antimutagenic, and immunomodulatory activities (Asian Pac. J. Cancer Prev. 2004;5:70-6). Much recent research has focused on these properties, as well as on evidence that the spice exhibits anticarcinogenic activity (Exp. Biol. Med. 2002;227:20-5). This column will briefly review the primary investigations of saffron that may potentially lay the groundwork for dermatologic applications.

Anticarcinogenic Actions

In 2004, Das et al. assessed the effects of an aqueous infusion of saffron on a two-stage skin papillogenesis/carcinogenesis mouse model, using 7,12-dimethyl benz[a]anthracin (DMBA) to initiate, and croton oil to promote, tumor formation. Saffron application was found to significantly decrease papilloma development during the pre- and postinitiation periods, especially when the saffron was administered during both periods. The authors attributed the inhibitory effects of saffron, at least in part, to the modulatory effects of C. sativus on phase II detoxifying enzymes, such as glutathione S-transferase, glutathione peroxidase, and superoxide dismutase (Asian Pac. J. Cancer Prev. 2004;5:70-6).

Early in 2009, Das et al. utilized a histopathologic approach to evaluate the chemopreventive effect of aqueous saffron on chemically induced skin carcinogenesis in mice. Animals were divided into five groups: three saffron-treated groups, a carcinogen control group, and a normal control group. Twice a week for 8 weeks, the carcinogen control and saffron groups were administered three topical applications of DMBA followed by croton oil on shaven dorsal skin. Only topical applications of the vehicle (acetone) were given to normal controls. The three saffron groups were orally fed with saffron infusions either before (group A), after (group C), or both before and after (group B) the application of DMBA.

Standard histologic examination revealed that the skin benefited from saffron treatments administered both before and after chemically induced skin carcinogenesis. Specifically, the saffron-fed groups exhibited inhibition of papilloma formation, as well as reductions in the size of papillomas that did form, compared with the control groups. The authors concluded that early treatment with saffron suppresses DMBA-induced skin carcinoma in mice, at least partly because of activation of cellular defense systems, namely cellular antioxidant enzymes (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]).

The anticarcinogenic properties of saffron were also demonstrated in much earlier studies. In 1991, Salomi et al. found that topical application of extracts of the common food spices Nigella sativa and C. sativus suppressed skin carcinogenesis initiation and promotion in a mouse model also using DMBA and croton oil. Specifically, they observed a delay in the formation of papillomas and a lower mean number of papillomas per mouse with application of a 100-mg/kg body weight dose of the extracts. They also evaluated the effects of the extracts on 20-methylcholanthrene (MCA)-induced soft tissue sarcomas in albino mice. Whereas tumor incidence was 100% in MCA-treated control mice, intraperitoneal administration of N. sativa and oral administration of C. sativus (both at 100 mg/kg body weight) 30 days after subcutaneous administration of MCA (745 nmol/day for 2 days) yielded tumor incidences of 33.3% and 10%, respectively (Nutr. Cancer 1991;16:67-72).

That same year, some of the same researchers, led by Nair, studied the antitumor activity of saffron extract against intraperitoneally transplanted sarcoma-180 (S-180), Ehrlich ascites carcinoma (EAC), and Dalton's lymphoma ascites (DLA) tumors in mice. The life spans of S-180, EAC, and DLA mice were increased respectively by 110.0%, 83.5%, and 112.5%, respectively, compared with baseline life spans, as a result of the oral administration of 200 mg/kg body weight of the saffron extract. In vitro, the extract was cytotoxic to S-180, EAC, DLA, and P38B tumor cells. The authors concluded that these results suggest the potential for saffron as an anticancer agent (Cancer Lett. 1991;57:109-14).

Speed Burn Healing

In a recent study of the potential role of saffron in wound healing, investigators compared the treatment of heat-induced burn wounds in rats using saffron pollen extract and silver sulfadiazine. Hot water was used to generate the wound. Rats were divided into four groups and treated with a topical cream control, base, saffron (20%), or silver sulfadiazine (1%) 24 hours after the induced injury.

Researchers measured wound size on day 25 and determined the average wound area to be 5.5, 4.1, 4, and 0.9 cm

Bioactive Components

In 2004, Giaccio evaluated the known constituents of saffron as well as its characteristics (e.g., antitoxic effects, hormonelike effects, and anticarcinogenic properties). Crocetin (8,8'-diapo-8,8'-carotenoic acid), a carotenoid and one of the main active ingredients in saffron, was of particular focus. This carotenoid is known to enhance oxygen's capacity to diffuse through liquids, including plasma, and has been shown to increase alveolar transport and cerebral and pulmonary oxygenation. Notably, crocetin also suppresses skin tumor promotion in mice and exhibits other anticarcinogenic properties, which are typically ascribed to its antioxidant activity. Although Giaccio highlighted the significant properties of a key constituent of saffron, the author acknowledged that the promising results associated with crocetin have been identified in vitro or in laboratory animals, but not in humans (Crit. Rev. Food Sci. Nutr. 2004;44:155-72).

In 2005, Assimopoulou et al. reported on a C. sativus extract (including crocin and safranal, two bioactive components). They found that a methanol extract of saffron demonstrated significant antioxidant activity against the 1,1-diphenyl-2-picrylhydrazyl radical. Crocin exhibited greater radical scavenging activity than safranal, but the scavenging capacity of the latter compound was still noted to be high. The investigators concluded that saffron has the potential for functional uses in foods, beverages touted for antioxidant activity, and medical purposes, namely in pharmaceutic and cosmetic formulations intended to confer antioxidant and antiaging activity (Phytother. Res. 2005;19:997-1000).

Conclusion

Although saffron has a long history of traditional uses, it is no turmeric in terms of the body of modern research and evidence. Nevertheless, current scientific investigations appear to be promising, suggesting a significant potential for the contemporary uses of this spice in medical practice. The data supporting saffron's antioxidant properties and successful topical use in animal models are encouraging. That said, while saffron is used as an oral supplement and in Ayurvedic medicine, much more research is necessary to determine its efficacy and effectiveness in topical skin care.

SAN FRANCISCO — An SPF 40 sunscreen containing two UVA filters—ecamsule and avobenzone—protected patients from flares of polymorphous light eruption significantly better than formulations containing only one UVA filter, in a large outdoor randomized trial.

La Roche-Posay's novel sunscreen, marketed over the counter by L'Oréal as Anthelios 40, contains ecamsule 3%, avobenzone 2%, octocrylene 10% for UVB protection, and titanium dioxide 5% as a physical filter providing protection across the UV spectrum.

Ecamsule provides enhanced protection in the short-UVA range, where avobenzone is less effective. Ecamsule protects against UV in the 290- to 400-nm range, with peak protection at 345 nm. It is also more photostable than avobenzone, Dr. Vincent DeLeo explained at the annual meeting of the American Academy of Dermatology.

Dr. DeLeo of St. Luke's-Roosevelt Hospital in New York reported on 144 adult patients with polymorphous light eruption (PMLE) who participated in the randomized, double-blind clinical trial. They applied the dual-UVA-filter sunscreen daily on one side of the body and the same product minus either the ecamsule or avobenzone on the other side. Then they went outdoors for controlled doses of natural sunlight.

The primary study end point was a composite efficacy measure consisting of delayed time to onset of PMLE or lower global flare severity, based on a 10-point scale assessing itching, papules, vesicles, and erythema.

In paired comparisons, the success rate was 56% with the dual-UVA-filter sunscreen, vs. 11% for the ecamsule-deprived sunscreen, and 36% with the dual-UVA-filter sunscreen, compared with 16% for the avobenzone-deprived product. Both differences were statistically significant.

Flares of PMLE occurred later and with a higher cumulative UVA dose with the dual-UVA-filter sunscreen than with either of the single-filter products.

L'Oréal, which funded the study, has exclusive patent rights to ecamsule (Mexoryl SX), approved by the Food and Drug Administration in July 2006 as the first new UVA filter in nearly 2 decades.

SAN FRANCISCO — An SPF 40 sunscreen containing two UVA filters—ecamsule and avobenzone—protected patients from flares of polymorphous light eruption significantly better than formulations containing only one UVA filter, in a large outdoor randomized trial.

La Roche-Posay's novel sunscreen, marketed over the counter by L'Oréal as Anthelios 40, contains ecamsule 3%, avobenzone 2%, octocrylene 10% for UVB protection, and titanium dioxide 5% as a physical filter providing protection across the UV spectrum.

Ecamsule provides enhanced protection in the short-UVA range, where avobenzone is less effective. Ecamsule protects against UV in the 290- to 400-nm range, with peak protection at 345 nm. It is also more photostable than avobenzone, Dr. Vincent DeLeo explained at the annual meeting of the American Academy of Dermatology.

Dr. DeLeo of St. Luke's-Roosevelt Hospital in New York reported on 144 adult patients with polymorphous light eruption (PMLE) who participated in the randomized, double-blind clinical trial. They applied the dual-UVA-filter sunscreen daily on one side of the body and the same product minus either the ecamsule or avobenzone on the other side. Then they went outdoors for controlled doses of natural sunlight.

The primary study end point was a composite efficacy measure consisting of delayed time to onset of PMLE or lower global flare severity, based on a 10-point scale assessing itching, papules, vesicles, and erythema.

In paired comparisons, the success rate was 56% with the dual-UVA-filter sunscreen, vs. 11% for the ecamsule-deprived sunscreen, and 36% with the dual-UVA-filter sunscreen, compared with 16% for the avobenzone-deprived product. Both differences were statistically significant.

Flares of PMLE occurred later and with a higher cumulative UVA dose with the dual-UVA-filter sunscreen than with either of the single-filter products.

L'Oréal, which funded the study, has exclusive patent rights to ecamsule (Mexoryl SX), approved by the Food and Drug Administration in July 2006 as the first new UVA filter in nearly 2 decades.

SAN FRANCISCO — An SPF 40 sunscreen containing two UVA filters—ecamsule and avobenzone—protected patients from flares of polymorphous light eruption significantly better than formulations containing only one UVA filter, in a large outdoor randomized trial.

La Roche-Posay's novel sunscreen, marketed over the counter by L'Oréal as Anthelios 40, contains ecamsule 3%, avobenzone 2%, octocrylene 10% for UVB protection, and titanium dioxide 5% as a physical filter providing protection across the UV spectrum.

Ecamsule provides enhanced protection in the short-UVA range, where avobenzone is less effective. Ecamsule protects against UV in the 290- to 400-nm range, with peak protection at 345 nm. It is also more photostable than avobenzone, Dr. Vincent DeLeo explained at the annual meeting of the American Academy of Dermatology.

Dr. DeLeo of St. Luke's-Roosevelt Hospital in New York reported on 144 adult patients with polymorphous light eruption (PMLE) who participated in the randomized, double-blind clinical trial. They applied the dual-UVA-filter sunscreen daily on one side of the body and the same product minus either the ecamsule or avobenzone on the other side. Then they went outdoors for controlled doses of natural sunlight.

The primary study end point was a composite efficacy measure consisting of delayed time to onset of PMLE or lower global flare severity, based on a 10-point scale assessing itching, papules, vesicles, and erythema.

In paired comparisons, the success rate was 56% with the dual-UVA-filter sunscreen, vs. 11% for the ecamsule-deprived sunscreen, and 36% with the dual-UVA-filter sunscreen, compared with 16% for the avobenzone-deprived product. Both differences were statistically significant.

Flares of PMLE occurred later and with a higher cumulative UVA dose with the dual-UVA-filter sunscreen than with either of the single-filter products.

L'Oréal, which funded the study, has exclusive patent rights to ecamsule (Mexoryl SX), approved by the Food and Drug Administration in July 2006 as the first new UVA filter in nearly 2 decades.

AUSTIN, TEX. — A chart review aimed at quantifying the incidence and type of periocular skin cancers showed that the vast majority were basal cell carcinomas, and that there was a slight predominance of the cancers in men.

The study was undertaken partly because there has been an increase in eyelid malignancies, which is thought to be due to a lack of protection from ultraviolet radiation, Dr. Jens Thiele said at the annual meeting of the American College of Mohs Surgery.

This is the largest U.S.-based study of periocular cancers ever conducted, said Dr. Thiele, a dermatologist in private practice in Birmingham, Ala.

He and his colleagues reviewed charts at a single center from 553 consecutive Mohs surgery patients from January 2005 to September 2008.

All of the patients were white (Fitzpatrick skin types I, II, and III). There were 346 men and 207 women. Interestingly, 61% of the tumors were in men.

Of the tumors, there were 435 basal cell carcinomas (BCCs), 105 squamous cell carcinomas (SCCs), 10 melanomas, and one of each of the following: sebaceous carcinoma, trichoepithelioma, and dermatofibrosarcoma protuberans.

The investigators also quantified location and pre- and postoperative defect sizes. Most often, BCCs were located on the lower eyelid (246, or 57%). They were also found on the medial canthus (28%), upper eyelid (10%), and lateral canthus (6%).

Squamous cell tumors also were found most frequently on the lower eyelid (64 or 61%), followed by the medial canthus (17%), the upper eyelid (15%), and the lateral canthus (7%), Dr. Thiele reported.

Six of the 10 melanomas were also on the lower eyelid; 8 of the tumors were in females.

For BCCs, the pre- and postoperative sizes were smallest on the upper eyelids, while the largest tumors were found on the medial canthus. The mean number of Mohs layers needed for BCC clearance ranged from 1.33 in the lateral canthus to 1.42 in the medial canthus.

SCCs had larger pre-op and postop sizes, but the number of layers needed for clearance was lower. The mean number for SCC clearance was 1.5 in the medial canthus and 1.1 in the lateral canthus, Dr. Thiele said.

Although this study confirmed the results of some large Australian databases, the chart review found a two fold higher occurrence of SCCs on the upper eyelid than had been reported previously, he noted.

Better knowledge of high-risk histologies and locations of periocular skin cancers should assist surgeons, said Dr. Thiele, who reported no conflicts.

AUSTIN, TEX. — A chart review aimed at quantifying the incidence and type of periocular skin cancers showed that the vast majority were basal cell carcinomas, and that there was a slight predominance of the cancers in men.

The study was undertaken partly because there has been an increase in eyelid malignancies, which is thought to be due to a lack of protection from ultraviolet radiation, Dr. Jens Thiele said at the annual meeting of the American College of Mohs Surgery.

This is the largest U.S.-based study of periocular cancers ever conducted, said Dr. Thiele, a dermatologist in private practice in Birmingham, Ala.

He and his colleagues reviewed charts at a single center from 553 consecutive Mohs surgery patients from January 2005 to September 2008.

All of the patients were white (Fitzpatrick skin types I, II, and III). There were 346 men and 207 women. Interestingly, 61% of the tumors were in men.

Of the tumors, there were 435 basal cell carcinomas (BCCs), 105 squamous cell carcinomas (SCCs), 10 melanomas, and one of each of the following: sebaceous carcinoma, trichoepithelioma, and dermatofibrosarcoma protuberans.

The investigators also quantified location and pre- and postoperative defect sizes. Most often, BCCs were located on the lower eyelid (246, or 57%). They were also found on the medial canthus (28%), upper eyelid (10%), and lateral canthus (6%).

Squamous cell tumors also were found most frequently on the lower eyelid (64 or 61%), followed by the medial canthus (17%), the upper eyelid (15%), and the lateral canthus (7%), Dr. Thiele reported.

Six of the 10 melanomas were also on the lower eyelid; 8 of the tumors were in females.

For BCCs, the pre- and postoperative sizes were smallest on the upper eyelids, while the largest tumors were found on the medial canthus. The mean number of Mohs layers needed for BCC clearance ranged from 1.33 in the lateral canthus to 1.42 in the medial canthus.

SCCs had larger pre-op and postop sizes, but the number of layers needed for clearance was lower. The mean number for SCC clearance was 1.5 in the medial canthus and 1.1 in the lateral canthus, Dr. Thiele said.

Although this study confirmed the results of some large Australian databases, the chart review found a two fold higher occurrence of SCCs on the upper eyelid than had been reported previously, he noted.

Better knowledge of high-risk histologies and locations of periocular skin cancers should assist surgeons, said Dr. Thiele, who reported no conflicts.

AUSTIN, TEX. — A chart review aimed at quantifying the incidence and type of periocular skin cancers showed that the vast majority were basal cell carcinomas, and that there was a slight predominance of the cancers in men.

The study was undertaken partly because there has been an increase in eyelid malignancies, which is thought to be due to a lack of protection from ultraviolet radiation, Dr. Jens Thiele said at the annual meeting of the American College of Mohs Surgery.

This is the largest U.S.-based study of periocular cancers ever conducted, said Dr. Thiele, a dermatologist in private practice in Birmingham, Ala.

He and his colleagues reviewed charts at a single center from 553 consecutive Mohs surgery patients from January 2005 to September 2008.

All of the patients were white (Fitzpatrick skin types I, II, and III). There were 346 men and 207 women. Interestingly, 61% of the tumors were in men.

Of the tumors, there were 435 basal cell carcinomas (BCCs), 105 squamous cell carcinomas (SCCs), 10 melanomas, and one of each of the following: sebaceous carcinoma, trichoepithelioma, and dermatofibrosarcoma protuberans.

The investigators also quantified location and pre- and postoperative defect sizes. Most often, BCCs were located on the lower eyelid (246, or 57%). They were also found on the medial canthus (28%), upper eyelid (10%), and lateral canthus (6%).

Squamous cell tumors also were found most frequently on the lower eyelid (64 or 61%), followed by the medial canthus (17%), the upper eyelid (15%), and the lateral canthus (7%), Dr. Thiele reported.

Six of the 10 melanomas were also on the lower eyelid; 8 of the tumors were in females.

For BCCs, the pre- and postoperative sizes were smallest on the upper eyelids, while the largest tumors were found on the medial canthus. The mean number of Mohs layers needed for BCC clearance ranged from 1.33 in the lateral canthus to 1.42 in the medial canthus.

SCCs had larger pre-op and postop sizes, but the number of layers needed for clearance was lower. The mean number for SCC clearance was 1.5 in the medial canthus and 1.1 in the lateral canthus, Dr. Thiele said.

Although this study confirmed the results of some large Australian databases, the chart review found a two fold higher occurrence of SCCs on the upper eyelid than had been reported previously, he noted.

Better knowledge of high-risk histologies and locations of periocular skin cancers should assist surgeons, said Dr. Thiele, who reported no conflicts.

AUSTIN, TEX. — Mohs surgery seems to be effective for primary sebaceous cell carcinoma when there is an absence of orbital extension, according to a retrospective case study.

Sebaceous cell carcinoma of the eyelid is extremely rare, but not uncommon, representing up to 5% of all eyelid tumors, Dr. Humza Ilyas of the University of Wisconsin, Madison, said at the annual meeting of the American College of Mohs Surgery. Dr. Ilyas presented a series of 16 cases that were seen at a single clinic from 1987 to 2008.

A major issue with these tumors is that they are frequently misdiagnosed histopathologically and clinically, said Dr. Ilyas. That causes a delay in diagnosis, so "it's important to maintain a high index of suspicion," he said. Patients who have the tumors typically do not do that well. Primary sebaceous cell carcinoma is complicated by recurrence, and it can be multicentric or demonstrate pagetoid spread.

In this case series, nine tumors (56%) were on the upper lid and seven (44%) were on the lower lid. The patients' mean age was 72 years, with a range of 51–90. Mean time from symptom onset to diagnosis was 8 months (range, 5 weeks to 2 years).

One patient had orbital extension, and exenteration was performed. All other patients had Mohs surgery (15), with a mean of 3.5 layers. One Mohs patient was lost to follow-up. Post-op follow-up ranged from 7 months to 14 years, with a mean duration of 4.5 years.

One (7%) of the 14 Mohs patients developed a local recurrence 1.5 years after surgery; that patient had exenteration as treatment and had no further evidence of disease 12 years later. Twelve of the 14 (86%) had no evidence of local recurrence.

Of the 14 who had Mohs, 6 (43%) had histologic evidence of pagetoid spread. There were no deaths attributable to the sebaceous cell carcinoma.

Dr. Ilyas said that although this was a small study, Mohs appears to be the most effective option for tumors with pagetoid spread. The outcomes were comparable to published series in the literature with conventional wide excision with frozen or paraffin margin controls, he said. There may be instances where adjunctive radiation or topical chemotherapy may be helpful.

Dr. Ilyas reported no disclosures.

AUSTIN, TEX. — Mohs surgery seems to be effective for primary sebaceous cell carcinoma when there is an absence of orbital extension, according to a retrospective case study.

Sebaceous cell carcinoma of the eyelid is extremely rare, but not uncommon, representing up to 5% of all eyelid tumors, Dr. Humza Ilyas of the University of Wisconsin, Madison, said at the annual meeting of the American College of Mohs Surgery. Dr. Ilyas presented a series of 16 cases that were seen at a single clinic from 1987 to 2008.

A major issue with these tumors is that they are frequently misdiagnosed histopathologically and clinically, said Dr. Ilyas. That causes a delay in diagnosis, so "it's important to maintain a high index of suspicion," he said. Patients who have the tumors typically do not do that well. Primary sebaceous cell carcinoma is complicated by recurrence, and it can be multicentric or demonstrate pagetoid spread.

In this case series, nine tumors (56%) were on the upper lid and seven (44%) were on the lower lid. The patients' mean age was 72 years, with a range of 51–90. Mean time from symptom onset to diagnosis was 8 months (range, 5 weeks to 2 years).

One patient had orbital extension, and exenteration was performed. All other patients had Mohs surgery (15), with a mean of 3.5 layers. One Mohs patient was lost to follow-up. Post-op follow-up ranged from 7 months to 14 years, with a mean duration of 4.5 years.

One (7%) of the 14 Mohs patients developed a local recurrence 1.5 years after surgery; that patient had exenteration as treatment and had no further evidence of disease 12 years later. Twelve of the 14 (86%) had no evidence of local recurrence.

Of the 14 who had Mohs, 6 (43%) had histologic evidence of pagetoid spread. There were no deaths attributable to the sebaceous cell carcinoma.

Dr. Ilyas said that although this was a small study, Mohs appears to be the most effective option for tumors with pagetoid spread. The outcomes were comparable to published series in the literature with conventional wide excision with frozen or paraffin margin controls, he said. There may be instances where adjunctive radiation or topical chemotherapy may be helpful.

Dr. Ilyas reported no disclosures.

AUSTIN, TEX. — Mohs surgery seems to be effective for primary sebaceous cell carcinoma when there is an absence of orbital extension, according to a retrospective case study.

Sebaceous cell carcinoma of the eyelid is extremely rare, but not uncommon, representing up to 5% of all eyelid tumors, Dr. Humza Ilyas of the University of Wisconsin, Madison, said at the annual meeting of the American College of Mohs Surgery. Dr. Ilyas presented a series of 16 cases that were seen at a single clinic from 1987 to 2008.

A major issue with these tumors is that they are frequently misdiagnosed histopathologically and clinically, said Dr. Ilyas. That causes a delay in diagnosis, so "it's important to maintain a high index of suspicion," he said. Patients who have the tumors typically do not do that well. Primary sebaceous cell carcinoma is complicated by recurrence, and it can be multicentric or demonstrate pagetoid spread.

In this case series, nine tumors (56%) were on the upper lid and seven (44%) were on the lower lid. The patients' mean age was 72 years, with a range of 51–90. Mean time from symptom onset to diagnosis was 8 months (range, 5 weeks to 2 years).

One patient had orbital extension, and exenteration was performed. All other patients had Mohs surgery (15), with a mean of 3.5 layers. One Mohs patient was lost to follow-up. Post-op follow-up ranged from 7 months to 14 years, with a mean duration of 4.5 years.

One (7%) of the 14 Mohs patients developed a local recurrence 1.5 years after surgery; that patient had exenteration as treatment and had no further evidence of disease 12 years later. Twelve of the 14 (86%) had no evidence of local recurrence.

Of the 14 who had Mohs, 6 (43%) had histologic evidence of pagetoid spread. There were no deaths attributable to the sebaceous cell carcinoma.

Dr. Ilyas said that although this was a small study, Mohs appears to be the most effective option for tumors with pagetoid spread. The outcomes were comparable to published series in the literature with conventional wide excision with frozen or paraffin margin controls, he said. There may be instances where adjunctive radiation or topical chemotherapy may be helpful.

Dr. Ilyas reported no disclosures.

ORLANDO — A prophylactic skin care regimen may prevent the severe rashes that afflict cancer patients treated with epidermal growth factor receptor inhibitors, according to a physician who conducted a randomized, controlled trial in 95 colon cancer patients.

Not only did the intervention reduce moderate to severe dermatologic side effects by more than half during the 6-week study, but investigators also were surprised to see adverse events such as diarrhea and neutropenia sharply reduced.

"Everything is cost effective," Dr. Edith P. Mitchell said, listing the generic products in the regimen during a press briefing at the annual meeting of the American Society of Clinical Oncology, where the study was presented.

The regimen includes sunscreen (for patients going out in the sun), a moisturizer, topical 1% hydrocortisone cream, and 100 mg of oral doxycycline, all given twice a day, explained Dr. Mitchell, program leader in gastrointestinal oncology at Thomas Jefferson University in Philadelphia.

Treatment should commence at least 24 hours before the start of anti-epidermal growth factor receptor (EGFR) therapy and continue throughout treatment, she said. One patient stayed on the prophylactic regimen for a year.

All patients in the STEPP (Skin Toxicity Evaluation Plan with Panitumumab) study were being treated with panitumumab (Vectibix), a monoclonal antibody approved as monotherapy for metastatic colorectal carcinoma that has progressed after standard chemotherapy. Although cetuximab (Erbitux), another EGFR inhibitor, was not involved in the trial, Dr. Mitchell said rash is a class effect of EGFR inhibitors. She also uses the regimen in patients receiving cetuximab.

Investigators randomized 48 patients to the prophylactic regimen and 47 patients to receive skin treatment reactively if they developed a rash. Dr. Mitchell reported 14 patients (29%) in the prophylactic group developed grade 2 or higher skin toxicity, compared with 29 patients (62%) in the control group.

Just 3 patients had grade 3 or higher dermatologic toxicity, compared with 10 patients in the control group. Those toxicities included dermatitis acneiform, pruritus, and pustular rash. None of the patients in either group had a grade 4 or 5 event.

Although the prophylactic group received more panitumumab doses (155 vs. 141) during the study, they had fewer doses of panitumumab delayed (1 vs. 9). That is considered important, because EGFR rashes are a problem affecting 90% of patients, causing some to delay and even to stop treatment, according to Dr. Mitchell. There have even been deaths due to infections associated with those rashes, she said.

A concern going into the study was that eliminating rash would interfere with the effectiveness of panitumumab.

Dr. Mitchell reported the regimen had no impact on efficacy of the colon cancer therapy. The overall response rate was 15% in the prophylactic arm and 11% in the control group; progression-free survival was 4.7 and 4.1 months, respectively.

The analysis also saw no difference between the two study arms when patients were analyzed for KRAS status.

Nondermatologic toxicities including grade 3 nausea, vomiting, fatigue, diarrhea, neutropenia, hypomagnesemia, and dehydration occurred less frequently in the prophylactic arm, as did grade 4 neutropenia. Neither group had any grade 5 toxicities.

Dr. Mitchell and many of her co-investigators disclosed financial relationships with Amgen, Inc., which makes panitumumab.

'Everything iscost effective,' and the skin care regimen had no impact on the cancer drug's efficacy. DR. MITCHELL

ORLANDO — A prophylactic skin care regimen may prevent the severe rashes that afflict cancer patients treated with epidermal growth factor receptor inhibitors, according to a physician who conducted a randomized, controlled trial in 95 colon cancer patients.

Not only did the intervention reduce moderate to severe dermatologic side effects by more than half during the 6-week study, but investigators also were surprised to see adverse events such as diarrhea and neutropenia sharply reduced.

"Everything is cost effective," Dr. Edith P. Mitchell said, listing the generic products in the regimen during a press briefing at the annual meeting of the American Society of Clinical Oncology, where the study was presented.

The regimen includes sunscreen (for patients going out in the sun), a moisturizer, topical 1% hydrocortisone cream, and 100 mg of oral doxycycline, all given twice a day, explained Dr. Mitchell, program leader in gastrointestinal oncology at Thomas Jefferson University in Philadelphia.

Treatment should commence at least 24 hours before the start of anti-epidermal growth factor receptor (EGFR) therapy and continue throughout treatment, she said. One patient stayed on the prophylactic regimen for a year.

All patients in the STEPP (Skin Toxicity Evaluation Plan with Panitumumab) study were being treated with panitumumab (Vectibix), a monoclonal antibody approved as monotherapy for metastatic colorectal carcinoma that has progressed after standard chemotherapy. Although cetuximab (Erbitux), another EGFR inhibitor, was not involved in the trial, Dr. Mitchell said rash is a class effect of EGFR inhibitors. She also uses the regimen in patients receiving cetuximab.

Investigators randomized 48 patients to the prophylactic regimen and 47 patients to receive skin treatment reactively if they developed a rash. Dr. Mitchell reported 14 patients (29%) in the prophylactic group developed grade 2 or higher skin toxicity, compared with 29 patients (62%) in the control group.

Just 3 patients had grade 3 or higher dermatologic toxicity, compared with 10 patients in the control group. Those toxicities included dermatitis acneiform, pruritus, and pustular rash. None of the patients in either group had a grade 4 or 5 event.

Although the prophylactic group received more panitumumab doses (155 vs. 141) during the study, they had fewer doses of panitumumab delayed (1 vs. 9). That is considered important, because EGFR rashes are a problem affecting 90% of patients, causing some to delay and even to stop treatment, according to Dr. Mitchell. There have even been deaths due to infections associated with those rashes, she said.

A concern going into the study was that eliminating rash would interfere with the effectiveness of panitumumab.

Dr. Mitchell reported the regimen had no impact on efficacy of the colon cancer therapy. The overall response rate was 15% in the prophylactic arm and 11% in the control group; progression-free survival was 4.7 and 4.1 months, respectively.

The analysis also saw no difference between the two study arms when patients were analyzed for KRAS status.

Nondermatologic toxicities including grade 3 nausea, vomiting, fatigue, diarrhea, neutropenia, hypomagnesemia, and dehydration occurred less frequently in the prophylactic arm, as did grade 4 neutropenia. Neither group had any grade 5 toxicities.

Dr. Mitchell and many of her co-investigators disclosed financial relationships with Amgen, Inc., which makes panitumumab.

'Everything iscost effective,' and the skin care regimen had no impact on the cancer drug's efficacy. DR. MITCHELL

ORLANDO — A prophylactic skin care regimen may prevent the severe rashes that afflict cancer patients treated with epidermal growth factor receptor inhibitors, according to a physician who conducted a randomized, controlled trial in 95 colon cancer patients.

Not only did the intervention reduce moderate to severe dermatologic side effects by more than half during the 6-week study, but investigators also were surprised to see adverse events such as diarrhea and neutropenia sharply reduced.

"Everything is cost effective," Dr. Edith P. Mitchell said, listing the generic products in the regimen during a press briefing at the annual meeting of the American Society of Clinical Oncology, where the study was presented.

The regimen includes sunscreen (for patients going out in the sun), a moisturizer, topical 1% hydrocortisone cream, and 100 mg of oral doxycycline, all given twice a day, explained Dr. Mitchell, program leader in gastrointestinal oncology at Thomas Jefferson University in Philadelphia.

Treatment should commence at least 24 hours before the start of anti-epidermal growth factor receptor (EGFR) therapy and continue throughout treatment, she said. One patient stayed on the prophylactic regimen for a year.

All patients in the STEPP (Skin Toxicity Evaluation Plan with Panitumumab) study were being treated with panitumumab (Vectibix), a monoclonal antibody approved as monotherapy for metastatic colorectal carcinoma that has progressed after standard chemotherapy. Although cetuximab (Erbitux), another EGFR inhibitor, was not involved in the trial, Dr. Mitchell said rash is a class effect of EGFR inhibitors. She also uses the regimen in patients receiving cetuximab.

Investigators randomized 48 patients to the prophylactic regimen and 47 patients to receive skin treatment reactively if they developed a rash. Dr. Mitchell reported 14 patients (29%) in the prophylactic group developed grade 2 or higher skin toxicity, compared with 29 patients (62%) in the control group.

Just 3 patients had grade 3 or higher dermatologic toxicity, compared with 10 patients in the control group. Those toxicities included dermatitis acneiform, pruritus, and pustular rash. None of the patients in either group had a grade 4 or 5 event.

Although the prophylactic group received more panitumumab doses (155 vs. 141) during the study, they had fewer doses of panitumumab delayed (1 vs. 9). That is considered important, because EGFR rashes are a problem affecting 90% of patients, causing some to delay and even to stop treatment, according to Dr. Mitchell. There have even been deaths due to infections associated with those rashes, she said.

A concern going into the study was that eliminating rash would interfere with the effectiveness of panitumumab.

Dr. Mitchell reported the regimen had no impact on efficacy of the colon cancer therapy. The overall response rate was 15% in the prophylactic arm and 11% in the control group; progression-free survival was 4.7 and 4.1 months, respectively.

The analysis also saw no difference between the two study arms when patients were analyzed for KRAS status.

Nondermatologic toxicities including grade 3 nausea, vomiting, fatigue, diarrhea, neutropenia, hypomagnesemia, and dehydration occurred less frequently in the prophylactic arm, as did grade 4 neutropenia. Neither group had any grade 5 toxicities.

Dr. Mitchell and many of her co-investigators disclosed financial relationships with Amgen, Inc., which makes panitumumab.

'Everything iscost effective,' and the skin care regimen had no impact on the cancer drug's efficacy. DR. MITCHELL

PRAGUE — A prior diagnosis of nonmelanoma skin cancer predicts an increased mortality risk in patients with chronic lymphocytic leukemia, investigators from the National Cancer Institute reported.

Overall, chronic lymphocytic leukemia (CLL) patients with a history of nonmelanoma skin cancer had a 30% greater risk of death, which almost doubled in the subgroup of patients with a prior diagnosis of squamous cell cancer, said Patrick Blake, a medical student at the Cleveland Clinic who is on leave at the NCI.

In one-third of the CLL cases, a diagnosis of nonmelanoma skin cancer preceded the leukemia diagnosis by less than 1 year, increasing to 44% for squamous cell cancer.

"CLL patients with a previous diagnosis of nonmelanoma skin cancer have a significantly decreased survival, compared with CLL patients without nonmelanoma skin cancer," Mr. Blake and colleagues reported during a poster session at the International Congress of Dermatology.

"Our investigation has unique new findings and expands the findings of two previous studies that found increased mortality among lymphoma patients with a prior history of skin cancer," he said.

Several case reports have documented incidental identification of subclinical CLL related to excision of squamous cell or basal cell skin cancer. A Scandinavian study of patients with squamous cell skin cancer demonstrated a twofold increased risk of CLL.

Two recent studies documented increased mortality in lymphoma patients with a history of skin cancer. However, investigators in both studies included CLL patients with those who had non-Hodgkin's lymphoma.

To clarify the link between CLL and nonmelanoma skin cancer, NCI investigators analyzed data from a population-based study of more than 12,000 cases of CLL diagnosed in Sweden between 1973 and 2003.

Complete medical history was available for the CLL patients, and cause of death was ascertained by data from Sweden's national death registry.

The NCI investigators identified 236 CLL patients with a prior diagnosis of nonmelanoma skin cancer, compared with 11,805 patients with no history of skin cancer.

CLL patients with a history of nonmelanoma skin cancer were:

▸ Older (78.5 years vs. 71 years);

▸ Substantially more likely to be age 70 or older at diagnosis of CLL (80.9% vs. 54.1%);

▸ More likely to be male (69.9% vs. 62%);

▸ And diagnosed more recently (1993 vs. 1984).

Among the 236 CLL patients with a history of nonmelanoma skin cancer, investigators found that 80 (34%) had a skin cancer diagnosis less than a year before the CLL diagnosis. Of 111 patients with squamous cell skin cancer, 49 (44%) had a skin cancer diagnosis less than a year before the CLL diagnosis.

CLL patients with a prior diagnosis of nonmelanoma skin cancer had a mortality hazard ratio of 1.29, compared with CLL patients who did not have a prior skin cancer diagnosis. In the subgroup of patients who had squamous cell skin cancer, the CLL mortality hazard ratio increased to 1.86. Both of these findings differed significantly from those of the patients with no history of skin cancer (P < .0001).

The 5-year survival of CLL patients without a history of skin cancer was 43%, compared with 31% for patients with a history of nonmelanoma skin cancer and 28% for the subgroup with squamous cell cancer (P < .0001).

PRAGUE — A prior diagnosis of nonmelanoma skin cancer predicts an increased mortality risk in patients with chronic lymphocytic leukemia, investigators from the National Cancer Institute reported.

Overall, chronic lymphocytic leukemia (CLL) patients with a history of nonmelanoma skin cancer had a 30% greater risk of death, which almost doubled in the subgroup of patients with a prior diagnosis of squamous cell cancer, said Patrick Blake, a medical student at the Cleveland Clinic who is on leave at the NCI.

In one-third of the CLL cases, a diagnosis of nonmelanoma skin cancer preceded the leukemia diagnosis by less than 1 year, increasing to 44% for squamous cell cancer.

"CLL patients with a previous diagnosis of nonmelanoma skin cancer have a significantly decreased survival, compared with CLL patients without nonmelanoma skin cancer," Mr. Blake and colleagues reported during a poster session at the International Congress of Dermatology.

"Our investigation has unique new findings and expands the findings of two previous studies that found increased mortality among lymphoma patients with a prior history of skin cancer," he said.

Several case reports have documented incidental identification of subclinical CLL related to excision of squamous cell or basal cell skin cancer. A Scandinavian study of patients with squamous cell skin cancer demonstrated a twofold increased risk of CLL.

Two recent studies documented increased mortality in lymphoma patients with a history of skin cancer. However, investigators in both studies included CLL patients with those who had non-Hodgkin's lymphoma.

To clarify the link between CLL and nonmelanoma skin cancer, NCI investigators analyzed data from a population-based study of more than 12,000 cases of CLL diagnosed in Sweden between 1973 and 2003.

Complete medical history was available for the CLL patients, and cause of death was ascertained by data from Sweden's national death registry.

The NCI investigators identified 236 CLL patients with a prior diagnosis of nonmelanoma skin cancer, compared with 11,805 patients with no history of skin cancer.

CLL patients with a history of nonmelanoma skin cancer were:

▸ Older (78.5 years vs. 71 years);

▸ Substantially more likely to be age 70 or older at diagnosis of CLL (80.9% vs. 54.1%);

▸ More likely to be male (69.9% vs. 62%);

▸ And diagnosed more recently (1993 vs. 1984).

Among the 236 CLL patients with a history of nonmelanoma skin cancer, investigators found that 80 (34%) had a skin cancer diagnosis less than a year before the CLL diagnosis. Of 111 patients with squamous cell skin cancer, 49 (44%) had a skin cancer diagnosis less than a year before the CLL diagnosis.

CLL patients with a prior diagnosis of nonmelanoma skin cancer had a mortality hazard ratio of 1.29, compared with CLL patients who did not have a prior skin cancer diagnosis. In the subgroup of patients who had squamous cell skin cancer, the CLL mortality hazard ratio increased to 1.86. Both of these findings differed significantly from those of the patients with no history of skin cancer (P < .0001).

The 5-year survival of CLL patients without a history of skin cancer was 43%, compared with 31% for patients with a history of nonmelanoma skin cancer and 28% for the subgroup with squamous cell cancer (P < .0001).

PRAGUE — A prior diagnosis of nonmelanoma skin cancer predicts an increased mortality risk in patients with chronic lymphocytic leukemia, investigators from the National Cancer Institute reported.

Overall, chronic lymphocytic leukemia (CLL) patients with a history of nonmelanoma skin cancer had a 30% greater risk of death, which almost doubled in the subgroup of patients with a prior diagnosis of squamous cell cancer, said Patrick Blake, a medical student at the Cleveland Clinic who is on leave at the NCI.

In one-third of the CLL cases, a diagnosis of nonmelanoma skin cancer preceded the leukemia diagnosis by less than 1 year, increasing to 44% for squamous cell cancer.

"CLL patients with a previous diagnosis of nonmelanoma skin cancer have a significantly decreased survival, compared with CLL patients without nonmelanoma skin cancer," Mr. Blake and colleagues reported during a poster session at the International Congress of Dermatology.

"Our investigation has unique new findings and expands the findings of two previous studies that found increased mortality among lymphoma patients with a prior history of skin cancer," he said.

Several case reports have documented incidental identification of subclinical CLL related to excision of squamous cell or basal cell skin cancer. A Scandinavian study of patients with squamous cell skin cancer demonstrated a twofold increased risk of CLL.

Two recent studies documented increased mortality in lymphoma patients with a history of skin cancer. However, investigators in both studies included CLL patients with those who had non-Hodgkin's lymphoma.

To clarify the link between CLL and nonmelanoma skin cancer, NCI investigators analyzed data from a population-based study of more than 12,000 cases of CLL diagnosed in Sweden between 1973 and 2003.

Complete medical history was available for the CLL patients, and cause of death was ascertained by data from Sweden's national death registry.

The NCI investigators identified 236 CLL patients with a prior diagnosis of nonmelanoma skin cancer, compared with 11,805 patients with no history of skin cancer.

CLL patients with a history of nonmelanoma skin cancer were:

▸ Older (78.5 years vs. 71 years);

▸ Substantially more likely to be age 70 or older at diagnosis of CLL (80.9% vs. 54.1%);

▸ More likely to be male (69.9% vs. 62%);

▸ And diagnosed more recently (1993 vs. 1984).

Among the 236 CLL patients with a history of nonmelanoma skin cancer, investigators found that 80 (34%) had a skin cancer diagnosis less than a year before the CLL diagnosis. Of 111 patients with squamous cell skin cancer, 49 (44%) had a skin cancer diagnosis less than a year before the CLL diagnosis.

CLL patients with a prior diagnosis of nonmelanoma skin cancer had a mortality hazard ratio of 1.29, compared with CLL patients who did not have a prior skin cancer diagnosis. In the subgroup of patients who had squamous cell skin cancer, the CLL mortality hazard ratio increased to 1.86. Both of these findings differed significantly from those of the patients with no history of skin cancer (P < .0001).

The 5-year survival of CLL patients without a history of skin cancer was 43%, compared with 31% for patients with a history of nonmelanoma skin cancer and 28% for the subgroup with squamous cell cancer (P < .0001).