Posts Tagged ‘studies’

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Melanoma News and Reviews – Ipi and "The Big C"

Friday, August 20th, 2010

Just watched the premiere of Showtime’s new hit, “The Big C,” in which Laura Linney plays a woman newly diagnosed with Stage Four Melanoma. The plot revolves around her decision to “carpe diem” and forgo traditional therapies to live out her anticipated remaining year joyfully and sometimes frivolously. As the show’s writer says,

“in many ways, this series is not about cancer per se.  It’s about living the life we want to live and not wasting our precious time!”

“Seizing the day” can be a good prescription for any human being, and I encourage it wholeheartedly (though not as foolhardily, perhaps, as she does, when she knocks down her porch and shade tree to spontaneously add a swimming pool to her small front yard!)  However, I would remind viewers that while the most serious and often most aggressive form of skin cancers, melanoma can be treatable and when caught early especially with proper screenings does not have to be a death sentence.

Aside from that, it is good to see the disease brought to light.  While there is not much apparent sidebar content or instructive information about melanoma on Showtime’s site, there is an alliance with the American Cancer Society that promises donations in exchange for viewing a clip of the show…a good approach to raise awareness of the show, for sure, but also for our passion: raising awareness about melanoma.

View Big C trailer to have $1 Donated, thanks to Showtime and American Cancer Society

View Big C trailer to have $1 Donated, thanks to Showtime and American Cancer Society

And here’s a link to the Big C Facebook page in case you want to participate there (to be sent right to that page be sure you’re logged in on Facebook) and weigh in.  Oddly, though, neither that Facebook page or the Showtime page for the show itself seem to provide any links to the More Birthdays Facebook page which they are supporting.  That is a lost opportunity to drive more donations and align themselves deeper with the cause.  Clearly, this is a “comedy that plays with dark and light tones.”  And entertainment sells, but there is always more room for responsible education, even if via links from their site.

In terms of Cathy’s life expectancy, as depicted on the show, it is, unfortunately fairly accurate:  The typical survival rate for patients with metastatic melanoma is six to nine months.  However, the new drug you may have read about here in June and elsewhere is continuing to show some promise in extended life expectancy, if slowly:

Metastatic melanoma patients who took the drug demonstrated a median survival rate of 10 months, a 3.6 month improvement over those who did not take the medication.

No one is laughing about the seriousness of melanoma.  But we all must just keep trying to find the joy, if even through television escapes.

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Spotlight on Melanoma

Friday, May 14th, 2010

Some might say that celebrities are over-exposed to the spotlight. And per our recent post on tanning, we’re seeing some celebs at least starting to minimize their over-exposure to sunlight (though sunless tans still abound), which helps raise awareness for skin cancer. Even the the legendary Bob Marley died from a cancer whose primary source was an acral melanoma under one of his toe nails. Bob Marley

Rare but tricky to spot sometimes, Acral melanoma accounts for about 5% of all diagnosed melanomas. It is, however, one of the most common forms of melanoma in Asians and people with dark skin, accounting for up to 50% of melanomas that occur in people with these skin types. (And this is very important since recent studies have shown that Hispanics and African Americans tend to delay seeking diagnosis or treatment.)

Acral melanoma is often referred to as a “hidden melanoma” because these lesions occur on parts of the body not easily examined or not thought necessary to examine. It develops on the palms, soles, mucous membranes (such as the lining of the mouth, nose and female genitals) and underneath or near fingernails and toenails.

Here is what it usually looks like on each area of the body:

Palms of hand or soles of feet: Melanoma usually begins as an irregularly shaped tan, brown or black spot. It can be mistakenly attributed to a recent injury.

Under a nail: The first sign may be a “nail streak” – a narrow dark stripe under the nail. A new nail streak not associated with recent trauma, an enlarging nail streak, a wide or very darkly pigmented streak, or a nail that is separating or lifting up from the nail bed should be examined by a doctor.

NB: Acral melanoma can also develop without any obvious nail streak – particularly the non-pigmented variety.

Include these areas in your skin self-exams especially during a celebrity-style manicure or pedicure!

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A Lighthearted Look at Dark Tans May Help

Tuesday, April 27th, 2010

The tanning bed culture is still, sadly, alive and hard to quell.

A new study released as shared by ABCNews says that "Increased regulation and warnings about the dangers of habitual tanning have not curbed visits to tanning booths, much to the chagrin of doctors and public health advocates,” and may even be "addictive” in some people.

The NY Daily News goes on to explain that "though the research did not definitively prove that tanning is an addiction, some researchers think that, for some people, it can be:

… In the study, 421 students were questioned about their tanning habits. Some 229 of the students used indoor tanning beds. In this group, some 30 to 40 percent met the psychiatric diagnostic criteria for addiction (depending on the scale that was used). The tanners in this group also reported higher use of marijuana, alcohol and other substances, and more anxiety symptoms. Dr. James Spencer, spokesman for the American Academy of Dermatology, told ABC News the study was “an eye opener.” “We think that tanning gives a brief cosmetic change for a lifetime of problems with skin cancer and wrinkles,” he said.

However, there’s good news and bad news from Hollywood on trademark tans.

In another story from NYDailyNews.com, a visual exposé of "Tanorexics” as they were called, shows that many celebs are opting for self-tanners, eschewing the skin-aging, sun-baking version.  ’Tanorexics’

That’s the good news.

The bad news is:

a) they are still fighting to achieve that look at all and

b) some of them are doing it, well, pretty poorly – the worst of them even earning

’Oompa Loompa’ is Not a Good Look for Skin

titles like "Oompa Loompas” or

"radioactive.”

As NYDailyNews.com also says, "tons of stars are sporting some seriously over-the-top tans.”

“Oompa Loompa” is Not a Good Look for Skin

We are heartened that the publication is taking blatant sides, and even heartthrobs are fair game. Captions like this may help move the needle on popularity more to the side of natural pale:

“New York city hotelier Andre Balazs may have been named one of GQ’s Top Ten Most Stylish Men in America, but his summer color is so last season.”

or:

“Las Vegas” actress Molly Sims is one gorgeous girl – but even a Sports Illustrated Swimsuit model can’t pull off the leathery look.”

Let’s hear it for the sunless goddesses like Bebe Neuwirth or Kate Winslet. Bebe Neuwirth

kate winsletFor more inspiration, you can even see Listal’s top 60 "Pale Actresses”!



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The Good Results are In

Friday, April 16th, 2010

The British Journal of Dermatology recently released a paper1 and editorial column2 demonstrating the effectiveness of the MoleMap program ("MoleSafe” here in the US originated in New Zealand and Australia as "MoleMap”) compared to a face to face dermatology visit.

Note: This blog post may be a little more formal and "scholarly” than my usual posts. I thought it was important to convey this compelling information accurately and as objectively as possible, so I’ll be including longer sections of quotes from the BJD paper.

The study, hoped to determine if patients could be screened for melanomas and other skin cancers effectively with the use of a teledermatology system (which includes the use of epiluminescence microscopy and macrophotograhy and forwards results to dermatologists) as triage (screening and prioritization) by general practitioners and lesion diagnosis clinics when using proper screening equipment, compared to face-to-face examinations by dermatology specialists.

Conducted in New Zealand, this was particularly valuable to that location since NZ suffers from one of the "highest reported incidence of melanoma and nonmelanoma skin cancers in the world” 1 while at the same time being challenged by an undersupply of dermatologists. In addition, some 15% of the population there lives more than an hour’s drive from a dermatologist. It’s not just essential to confirm the value of teledermatology in that country, but also in all places where "the technology could be used as a triage tool to reduce waiting lists and thus improve access to the public hospital lesion diagnosis clinic.”

As a matter of fact, this was reported in the British Journal of Dermatology because of the interest in determining if this would be a good solution in Great Britain where current U.K. National Institute for Health and Clinical Excellence (NICE) guidelines dictate that all suspected skin malignancy should be seen face to face, and the use of teledermatology for pigmented lesions remains controversial.

"However, the incorporation of high-quality teledermoscopic images in addition to macroscopic images may challenge this view.”2

Indeed, the researchers comment in their conclusion that:

Teledermoscopy offers considerable potential to reduce patient travel costs and waiting time, and thus to increase access to specialist care. …We hope to integrate this technology into the public health service as it is already in use in NZ and Australia within the private sector (MoleMap programme).1

We read the results of this clinical study with great interest, and some pride, since our sister [parent?] company, MoleMap New Zealand, was selected to supply the quality equipment and trained technicians. That is significant is because lesser quality methods and equipment used in earlier studies to compare diagnoses done via face-to-face exams vs preliminary screenings with teledermoscopy led to lesser consensus:

The use of a melanographer skilled in digital and dermoscopic imaging melanographerensured consistently high image quality. Earlier trials have been hampered by inconsistent digital images and often required the general practitioner to obtain the image. Image quality depends on training, experience and time, which may not be practical for a busy general practitioner.1

This also supported of the value of including Dermoscopy, which is an essential component of any MoleSafe exam, over just macro-photography, as used by some physicians:

"Concordance of teledermoscopy to face-to-face diagnosis in this study was much higher than that reported in earlier trials. This in part reflected the greater specificity that Dermoscopy has over simple macro photography in the triage of lesions.”1

How It Was Conducted:

First, the study set out to "assess the accuracy and reproducibility of teledermatology including dermoscopic images (teledermoscopy) compared with face-to-face assessments by dermatologists.” Some two hundred patients with a total of 491 lesions were seen by a dermatologist, and also screened with same methods used by the MoleMap/MoleSafe program with the results sent to the doctors for review.

All patients were seen face to face by two out of three dermatologists, and after a period of 4 weeks the same lesions were reviewed anonymously by two using a standardized history, macro digital images and corresponding dermoscopic images.2

The results were that there was excellent agreement between teledermoscopy and face-to-face diagnosis.

We have shown that 136 of 200 patients (constituting 74% of lesions) could have been spared a face-to-face consultation through using teledermoscopy as the preliminary assessment.1

The agreement in assessment of more significant lesions was an even better 83% for both face-to-face and teledermoscopy. But what was particularly interesting is that the type of scanning and review done by MoleSafe — including histological examination of suspected malignant lesions — showed the teledermoscopic diagnosis to be more accurate than face-to-face diagnosis.

"This seemingly unlikely observation may relate to the ability to enlarge and contemplate images on a computer screen which is simply not possible during examination of the patient with a hand-held dermatoscope.”2

It’s also important to note that reproducing the study’s results are contingent on the training and experience of the dermatologist, both of whom in the trial were experienced in tele-dermatology and dermoscopy. And when done in conjunction with a whole-body exam, again, as we do at MoleSafe, and as done in a naked eye exam by your dermatologist, results should be even more significant:

"…this store-and-forward form of teledermoscopy provided only images of the lesions of concern and did not permit a whole-body examination. The use of a whole-body teledermoscopy service may overcome this limitation, and a recent analysis of 100 consecutive melanomas diagnosed by MoleMap NZ showed that 37% of patients were unaware of their melanoma.”1

Here’s the takeaway…

In the future, general practitioners may be able to refer a patient with suspicious skin lesions to a ‘virtual lesion clinic’ for triage. Perhaps there will soon be mobile clinics since "the technology is portable, easy to operate and images can be transmitted via a virtual private network to the teledermoscopists – overcoming geographical barriers and delivering service to remote areas.”

What does this study add?

• Teledermoscopy approximated 100% sensitivity and 90% specificity for detecting melanoma and nonmelanoma skin cancers.

• Importantly, 74% of all lesions were determined to be manageable by the general practitioner without needing to be seen face-to-face by a dermatologist.

• This use of teledermoscopy as a triage tool offers the potential to shorten waiting lists and thus improve healthcare access and delivery.1

Simply put, this is a clarion call for the value and effectiveness of the kinds of screenings that are conducted by MoleSafe and MoleMap and we are proud to be at the leading edge of skin cancer detection and awareness.

1Source: British Journal of Dermatology, 12/09: "Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial)” by E. Tan, A. Yung, M. Jameson,* A. Oakley and M. Rademaker  Journal Compilation ©2010 British Association of Dermatologists • British Journal of Dermatology 2010 162, pp803–811

2Commentary: British Journal of Dermatology – "Does teledermoscopy validate teledermatology for triage of skin lesions?” S. M. Halper 2010

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The Beginning of the End? Melanoma Drug Trials and Tribulations

Wednesday, February 24th, 2010

This week, The New York Times published a series of three articles about the roller-coaster of excitement and frustrations surrounding a promising new drug therapy for melanoma. The series follows the trials, successes and tribulations of a targeted drug, PLX4032, which is specifically beneficial only to those with a B-RAF gene mutation spurring their cancer.

It’s important and excellent reading.

Dr. Flaherty with clinical trial patient

Dr. Flaherty with clinical trial patient

Randy Williams, 46, who drove 600 miles from his home in Jonesboro, Ark., to the M.D. Anderson Cancer Center in Houston to get the experimental drug, rolled out of bed. "Something’s working,” he thought, "because nothing’s hurting.”

It was a sweet moment, in autumn 2008, for Dr. Keith Flaherty, the University of Pennsylvania oncologist leading the drug’s first clinical trial. A new kind of cancer therapy, it was tailored to a particular genetic mutation that was driving the disease, and after six years of disappointments his faith in the promise of such a "targeted” approach finally seemed borne out. His collaborators at five other major cancer centers, melanoma clinicians who had tested dozens of potential therapies for their patients with no success, were equally elated.

But the titles of each article in the series give away the plot:

After Long Fight, Drug Gives Sudden Reprieve

then

A Roller Coaster Chase for a Cure

and finally:

A Drug Trial Cycle: Recovery, Relapse, Reinvention.

My takeaway:

With no significant change in the treatment of advanced stage melanoma in over twenty years this is a great break through. But it’s not the end. It’s the beginning of the end. With a long road to follow.

Still early detection avoids the need for these treatment and the possibility of treatment failure. So, be vigilant. Check your skin and the skin of the people you love. Reduce your risk factors. See your dermatologist on a regular basis. Have your MoleSafe procedure.

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Melanoma Shows no Favorites

Thursday, January 7th, 2010

The wealthy or the poor. African American or Caucasian. Melanoma is non-discriminating. Two news stories this past week showed just how this assassin has no loyalties.

FDR and Melanoma

In a new book, "F.D.R.’s Deadly Secret,” by neurologist Dr. Steven Lomazow, and journalist Eric Fettmann, Franklin D. Roosevelt’s death is hypothesized to have been from melanoma. The authors point out various symptoms and medical/political cover-ups, most specifically a disappearing mole in photos over the years.

The book has served to create additional speculation even if it still has not unshrouded the mystery to the satisfaction of many historians. But it has also served to do what we try to do here at Melanoma Updates as well: increase awareness of the deadly trajectory of late or undiagnosed melanomas.

Equal Opportunity Disease

Other melanoma news this week that is more substantiated was about the disparity in skin cancer diagnoses and deaths among Hispanics and African Americans

While the actual incidents of skin cancers and melanomas are lower, African Americans are more than twice as likely as Caucasians to have a melanoma that had spread “regionally or to distant parts of their bodies” at the time of diagnosis. Based on a study of 41,000 cases of melanoma diagnosed in Florida between 1990 and 2004, 12% of white non-Hispanic patients had advanced cancer by the time they were given a diagnosis, 18 % of Hispanic patients and 26% of black patients were at this later stage, when the cancer had already spread.

Granted, the study was based in sun-drenched Florida, but the study’s authors feel a contributing factor may be that Hispanics and blacks might put off seeing a doctor about melanoma lesions because they’re under the impression it’s a whites-only disease. As written in NewsOK:

They’re mostly right, but not completely: … According to the National Cancer Institute’s online database, 28.9 of every 100,000 white men are diagnosed with melanoma, and 18.7 of every 100,000 for white women. For Hispanic men and women, the rates are 4.7 and 4.6; for blacks, it’s 1.1 and 1. Overall, the median diagnosis age is 59.

But the survival rate for whites has gone from 68 percent in the early 1970s to 92 percent in recent years, the study says. “Such advances, however, have not occurred in other racial and ethnic groups in the United States.

And, as summed up in The New York Times version of the story:

"The simple message is that even though blacks and Hispanics are at lower risk, they can still get melanoma, but there seems to be a lack of awareness, so they’re diagnosed at a later stage,” said Dr. Robert S. Kirsner, the paper’s senior author and vice chairman of dermatology at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.

The takeaway? Everyone still has to be vigilant.

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