Time to learn our ABCD’s

photo credit: bettergov.org

photo credit: bettergov.org


The ABC’s. It’s one of the first things we learn as kids right? We even have a catchy little song to help make the alphabet easier to remember. It seems pretty simple….until it isn’t. In the field of dermatology the alphabet is used as an acronym for the clinical detection criteria of melanoma, the deadliest form of skin cancer. The conventional ABCDE’s of melanoma are Asymmetry, Border, Color variegation, Diameter >6mm, and Evolution [any change in morphology or symptoms of the lesion]. A recent study conducted through the University of California, San Francisco, has demonstrated that we need to learn some new ABCD’s. This retrospective study evaluated patients diagnosed before the age of 20, during the time period from 1984-2009. 60 pediatric patients with melanoma as well as 10 pediatric patients with ambiguous melanocytic tumors treated as melanoma (i.e. lesions had atypical clinical presentations and ambiguous microscopic features). The study patients were divided into group A for ages 0-10 and group B for ages 11-19. The conventional clinical ABCDE detection criteria was absent in sixty percent of group A patients and 40 percent of group B patients. What emerged from the study was a new set of ABCD’s common to diagnosis including Amelanosis (lack of pigment), Bleeding and “bumps”, uniform Color, variable Diameter and De novo development. Not only were the clinical features different from the conventional, but it was also found that current microscopic subtypes of melanoma could not be applied to 44 percent of cases.

What does this all mean? It means that more research will need to be done to expand upon this research to help determine the most appropriate clinical and microscopic detection criteria for melanoma as it relates to the pediatric population. The good news, is that it means that the field of dermatology continues to evolve and change as new information reaches the forefront to best diagnose and manage our patients. It also means that as parents and caregivers of children we need to have a heightened awareness of bleeding lesions, bumps and lumps both colored and colorless that have newly developed or recently changed and have them evaluated. It means we need to learn our ABCD‘s.

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Fountain of youth

fountain_of_youth_3sfw

Ok, ok, so maybe it’s not the actual “fountain of youth”, but recent research has highlighted that daily sunscreen use can slow the signs of aging. For reals. The recent Annals of Internal Medicine study demonstrated that study participants (adults younger than 55) who used sunscreen daily showed no detectable increase in skin aging after 4.5 years. As another plug for daily sunscreen use, the study showed that skin aging from baseline to the end of the trial was 24% less in the daily sunscreen group compared to a group of adults using sunscreen at their discretion. As with most data, additional research should be done to further investigate results, but in the meantime if you are looking to maintain those youthful good looks, try adding sunscreen or moisturizer with sunscreen into your daily routine and make it a habit.
See you in the shade!

Time to celebrate!

Camp Korey

Today is a day of celebration. We celebrate our country. We celebrate the freedoms we enjoy as a result of our forefathers declaration of independence. We celebrate the special memories we get to create with family and friends as we gather around picnic tables, bonfires and watch Technicolor fireworks illuminate the sky in honor of this declaration. Sure, we celebrate a day off work and throw in some good sales too, why not? In the spirit of celebration and honoring amazing things, I wanted to share my adoration for Camp Korey. What is Camp Korey? I am so glad you asked! Camp Korey is an amazing haven that provides recreational programs for children and young adults with serious medical conditions who are unable to attend traditional enrichment programs due to their high medical needs. Camp Korey is a place that provides kids the opportunity to build self-esteem, meet friends that can relate to similar challenges and empower them to try new things rather than feeling isolated or limited as they might elsewhere. It is the place where pure joy is palpable.

I had the privilege of volunteering at Camp Korey as medical staff this past week. On a larger scale, the camp is part of the Serious Fun Children’s Network and in partnership with the American Academy of Dermatology hosts Camp Reflection, which is a camp specifically geared towards children with skin disorders and is held on the Camp Korey campus. As a dermatologist, I had the opportunity to oversee the medical care of children with both relatively common skin conditions such as atopic dermatitis to rare entities that most of us only read about during our training. The diversity of skin disorders at camp may have been vast, but the love of fun, camaraderie, mutual respect and unwavering support was homogenous. The kids had a blast, and no one was left behind or left out. From the beginning of camp where a young woman had such severe social anxiety that she wouldn’t utter a word to me, to the end of camp where she bestowed upon me a smile that could light up the darkest of skies, it was magical. Although I was there to serve in a professional capacity as a physician, I was gifted a profound personal re-awakening. Today is a day of celebration of our nation’s independence, but I would suggest that every day should be a celebration. The kids at Camp Korey reminded me that we can and should celebrate our abilities, but we should also celebrate our limitations to help catapult us beyond them to achieve true bliss. Happy 4th everyone!

What you didn’t expect when you’re expecting

Aah, the joys of pregnancy. You are basking in the glory of carrying your bundle of love. Your hair is more lush and plentiful, you have that “glow”, you can indulge your every craving guilt free, and you can finally fill out that low-cut top you’ve coveted without any er, um…supplemental padding. But alas, you discover that the “Girlfriend’s guide to pregnancy” left out a few significant details about what could happen to your skin over the course of those nine months. Well, girlfriend, I’m here to tell you ugly truth. Your skin is your window to what’s happening on the inside. With a baby growing inside of you, your body is functioning in overdrive and all that growth and change happening for the baby translates into a lot of growths and changes with your skin, hair and nails. Having gone through this process a few times myself, I have had the unfortunate pleasure of experiencing a few of these lovelies and the good news is that most of the changes I’ll detail below do go away after pregnancy, and those that linger can be “taken care of” shall we say, by your local dermatologist. So even though you didn’t expect these things when you found out you were expecting, don’t worry, I’m here to guide you through it.

Lumps, bumps and tags oh my!

photo credit: skincare-service.com

photo credit: skincare-service.com


a.Common benign growths during pregnancy include skin tags also known as acrochordons or fibroepithelial polyps which love to occur in all the inconvenient places like crevices and skin folds for example around your neck, in your armpits, along your bra line and groin. They also like the face, especially around the eyes. Skin tags are typically skin colored or hyperpigmented(darker)lesions 2-5mm in size that may be smooth or irregular in appearance and are often raised from the surface of the skin on a fleshy stalk. They are usually asymptomatic unless they get irritated or itchy from being rubbed by clothing or jewelry. Other than being seen during pregnancy, skin tags may have a causal genetic link as well as a link to metabolic syndromes such as diabetes. These lesions can easily be removed if desired or warranted via cauterization, cryosurgery, excision or surgical ligation.

b. Seborrheic keratoses:

photo credit: finantempleton.com

photo credit: finantempleton.com


These benign lesions are raised thickenings of the skin that typically appear as variable shades of brown and can appear black at times raising concern for a differential diagnosis of melanoma and therefore are likely to be biopsied for confirmation. Some refer to seborrheic keratosis as “barnacles on the ship of life” as they typically appear later in adult life. I personally refer to them as “gifts of maturity”. Now granted, it’s like the gift from your Aunt Minny, you really don’t want the gift, you have no need for it and it’s downright ugly, but you can’t give it back and you can’t exchange it, so you might as well make the most of it and give it a nice name right? Just like tags, they don’t need to be removed, but if they become irritated or bothersome the same methods of removal for tags can be used for seborrheic keratoses.

c. Pyogenic granuloma:

photo credit: procedureclinic.com

photo credit: procedureclinic.com


These lesions are also referred to as granuloma gravidarum, eruptive hemangioma, granulation tissue-type hemangioma, lobular capillary hemangioma, and tumor of pregnancy. I had the distinct displeasure of having one of these in my mouth during pregnancy, a common location, and in this location it is coined an “epulis of pregnancy”. A pyogenic granuloma or epulis is essentially granulation tissue which appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors. Because they are composed of groups of blood vessels they are extremely friable and can bleed significantly with minor trauma. The good news is that they often resolve spontaneously. The caveat is that if a lesion doesn’t resolve on it’s own and removal is performed but incompletely so, the lesion can recur with “friends” i.e. multiple lesions can occur. Again, being a benign lesion this is not a long term concern, but acutely it can raise false alarm for more concerning skin conditions including malignancy if you don’t inform your doctor of your prior procedure.

d. Cherry angiomas:

photo credit: byebyedoctor.com

photo credit: byebyedoctor.com


Who doesn’t like a cherry on top? Well, when it comes to having them all over your body you may not. Cherry angiomas are another vascular benign neoplasm that can occur at all stages of life from childhood to adulthood, but it seems that during pregnancy they like show up even more. These lesions range from 2-5mm and may be flat or raised. The larger the lesion, the more likely that it may bleed with minor trauma. An important thing to know about these lesions that if they do become traumatized they take on a blue/black appearance which similar to seborrheic keratoses, can mimic melanoma and prompt a biopsy to rule out this possibility. Unlike pyogenic granulomas and skin tags, cherry angiomas linger long after pregnancy and in most cases become a permanent fixture on your body. Like most other lesions though they can be removed via excision, cauterization or laser therapy.

e.Nevi/moles:

photo credit: hawaiidermatology.com

photo credit: hawaiidermatology.com

These are benign lesions comprised of melanocytes which are your pigment producing cells. They range in color from flesh-colored to shades of brown. Melanocytes are also the cells which give rise to melanoma, the deadliest form of skin cancer. Melanoma can arise de novo, meaning the lesion originates as a cancer, or it can evolve from a pre-existing nevus/mole that undergoes changes in terms of its size, shape and color. During pregnancy it is not uncommon that pre-existing nevi/moles become darker than they were at their onset due to an increase in a hormone called melanocyte stimulating hormone. This darkening effect can be seen in other areas where melanocytes are found including genital skin, breast areolar tissue and that line from your belly button to your pubic area which is referred to as the linea nigra. Following pregnancy, the affected lesions and skin may return to their previous state, though more commonly they remain slightly darker than they were originally. The concern for melanoma is low in these situations unless it is noted that a pre-existing lesion has significantly changed in size, shape as well as color or a new lesion has appeared during pregnancy that stands out from all the other lesions a patient has, both of these scenarios may prompt a biopsy for further evaluation.

There are a host of other issues that may arise during pregnancy including: soft, brittle nails that grow at warp speed; outbreaks of acne; spider veins; stretch marks; melasma (patchy darkening of facial skin: the key is sun protection); new rashes that itch as well as exacerbation and new manifestations of underlying skin conditions like psoriasis and immuno-bullous disease. And if that weren’t enough, that luscious head of hair you acquired during pregnancy is going to start to shed starting around 3 months postpartum and last for about 3 months known as telogen effluvium. Sounds awful doesn’t it? Don’t worry, most women experience a few of these things but not all of them, and most of these issues resolve spontaneously. For all other issues and any lesions that concern you, consult your local dermatologist.

Pregnancy may not be all rainbows and butterflies, but at least now you know what to expect right? Good luck and enjoy the journey!

Mirror, mirror on the wall

photo credit: oocities.com

photo credit: oocities.com

Who’s the fairest of them all?  Fair, pale, au natural…..even fairy tales love sun-protected skin. I know, I know, that’s not what the Queen had in mind, but this is my story now so indulge me. What was the Queen longing to see when she looked in the mirror? She desired a youthful appearance, like that of Snow White, with a face free of wrinkles, brown spots, dilated pores and blood vessels. I know that’s what I long to see when I look in the mirror, how about you?

Unfortunately, despite my career choice to nurture and protect skin as a dermatologist, as a kid and teenager I was not a skin nurturer, in fact, I was a down-right skin-abuser. I burned, fried and tanned my skin any chance I could get. My sister and I would have contests to see how long we could lay out in the sun before we nearly passed out from heat exhaustion or play the game of “how low can you go” with the SPF factor on our “suntan oil.” Yes, oiling our hide to tan it was the object of the game. Thankfully we quit playing before our hide became leather…. but barely. Instead of leather, I got lots of freckles and moles (a direct correlation of sun-damage), many of which have been biopsied and been proven to be atypical histopathologically. In essence, I am my own skin nightmare with scars all over my body as a constant reminder that I’m not dreaming.

Premature wrinkling, sagging skin, freckles, dilated facial blood vessels and brown spots are manifestations of sun-damage which is referred to as photo-aging or if you want to be fancy, dermatoheliosis. Compared to physiologic (chronologic) aging, the changes seen with photo-aging are accelerated with the end result of having you looking significantly older than your stated age. Sure, as teenagers some of us wanted to look older so we could get into establishments with age restrictions, but as adults I think many of us are thrilled when someone mistakes you for someone’s “younger sibling.” Maintaining a youthful appearance is the reason the cosmetic/aesthetic procedure industries have exploded in recent years with new products and innovations.

The good news is that you don’t have to spend a fortune to maintain your youthful looks! Just a few minor adjustments to your daily routine will help you minimize the damaging effects of the sun on your skin. Daily use of sunscreen, either in your moisturizer, after-shave cream or make-up is a simple way to layer on your sun protection on all your exposed skin. It’s the UVA rays which are the “aging” rays, so make sure the products you buy are labeled “broad-spectrum” so that you get coverage for both UVA and UVB (the burning rays). Remember, UVA rays can penetrate window glass, so while you are driving in your car and sitting by your office window you are still get “sun.” If you have ever noticed that the left side of your face and left arm have more spots and lines on them, this is one of the big reasons as your left side gets bombarded by UVA rays while you are driving. The recommendation is to use products that are SPF (sun protection factor) 15 or higher and I like to use SPF 30 in my daily moisturizer. Choosing products that have zinc oxide and titanium dioxide will minimize irritation for those of you with sensitive skin. There has been much controversy over nano-sized particles of these ingredients, although the research is still ongoing, there are plenty of fantastic products currently on the market that do not use nano-sized particles. Remember, whichever products you choose to use, sunscreens regardless of SPF or active ingredient will break down approximately 2 hours after application, so if you are planning on being outdoors for an extended period of time you need to reapply. There’s no reason you can’t look good while maintaining your youthful appearance right? So wear some fashionable sun-protective clothing (check back with me soon for a preview), a broad-brimmed hat, and don some shades to protect those eyes because ocular melanoma is challenge to treat so prevention is key.

Mirror, mirror on the wall who’s the fairest and most youthful looking of all? My sun-protected shaded bliss fans of course! See you in the shade!

Orange and chocolate does the body good

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For those of you who have been reading my posts lately, I realize you may think I am starting to sound like Charlie Brown’s teacher (“whah whah whah, whah,”) since I talk about skin cancer so much ( I am a dermatologist after all), but orange and chocolate are really a great combination for your skin so hopefully you will indulge me. May is skin cancer awareness month and to kick off the month, today is known as “Melanoma Monday.”  Dermatologists across the country will be wearing orange to bring attention to a campaign headed up by the American Academy of Dermatology to promote skin cancer awareness and skin cancer screenings.  We dedicate today to raising awareness about melanoma, because although it accounts for less than 5% of skin cancer cases, it is the cause of the majority of skin cancer deaths. 

Here are top 10 facts you should know about melanoma*: 

  • 1 in 50 men and women in the U.S. will be diagnosed with melanoma of the skin during their lifetime.
     
  • Melanoma is the fifth most common cancer among men and the seventh most common cancer in women in the US and it is the only cancer whose incidence continues to rise nearly 2% annually. 
  •  In 2009, there were approximately 876,344 men and women alive in the U.S. with a history of melanoma. This number continues to rise.
     
  • Approximately 86 percent of melanomas can be attributed to exposure to ultraviolet (UV) radiation from the sun.
     
  • Melanoma is one of only three cancers with an increasing mortality rate for men, in addition to liver and esophageal cancers.
     
  • Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.
     
  • The vast majority of mutations found in melanoma are caused by ultraviolet radiation.
     
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
     
     
  • A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.
     
  • One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.

So if you see someone wearing orange today, hopefully it will prompt you to check your skin for any new or changing spots. As dermatologists we look for “the ugly duckling” on your skin; the spot that stands out from your “crowd” of spots and the sore that isn’t healing in a timely fashion. This month, and today in particular, is a time we encourage you to do the same with your skin. If you have any concerns or questions regarding your “spots”, it’s always best to seek consultation with a dermatologist in case a biopsy needs to be performed.

Ok, so now that your brain is full of facts that admittedly are a bit frightening and overwhelming, I am here to cheer you up with chocolate! That’s right chocolately deliciousness to bring you back to your comfort zone. The key ingredient in chocolate is cocoa, which is rich in anti-oxidants, richer in fact than red wine or green tea. Recent research* highlighted the group of anti-oxidants known as flavanols (a group of compounds that can be particularly rich in cocoa) and that have been previously reported to improve blood flow and vessel function. The study revealed the potential benefits of consuming flavanol-rich cocoa and how it might actually benefit the appearance of skin from the inside out including: increasing hydration, decreasing skin roughness and scaling, and helping to support the skin’s defense against UV damage.  Good news right? Chocolate without guilt, what could be better?

So to celebrate “Melanoma monday”, put on your orange clothes, check your skin and get in the kitchen to eat some flavanols and cocoa with this chocolate chocolate chip cookie recipe that is kid tested and approved (and I have some pretty picky eaters around here!)
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2 1/4 c unsifted flour (can use brown rice flour for gluten free option)

1 tsp baking soda

1/2 tsp salt

3/4 c fair trade raw cane sugar (or whatever you got in the cupboard)

3/4 c organic light brown sugar, packed

2 tsp vanilla extract

2 eggs 

1/2 c butter

1/2 c pumpkin puree

1/4 c cacao powder

10 oz  chocolate chips ( I used Ghiradelli 60% Cacao bittersweet chips)

Preheat oven to 375F. Combine flour, baking soda, salt and cacao and set aside. Beat butter, pumpkin, sugar and eggs at medium speed until creamy. Add vanilla and eggs, one at a time, mixing on low speed until well blended.

Add your dry ingredients into creamed mixture gradually and then add your chocolate chips. On a cookie sheet drop your preferred size cookie (tablespoon or bigger/smaller) and bake for 9-11 minutes or until golden brown. Depending on cookie size makes about 4 dozen.

Voila! Comfort food that has the potential to be good for your skin and for your soul!

These cookies are a bit more cakey due to the pumpkin. You can use a full cup of butter if you don’t like the consistency. Enjoy!

*References:

1. Skincancer.org

2. Heinrich U, Neukam K, Tronnier H, Sies H, Stahl W. Long-term ingestion of high flavanol cocoa provides photo protection against UV-induced erythema and improves skin condition in women. J Nutr. 2006 Jun; 136(6):1565-9.

 

Being sun-smart just got smarter

photo credit: actcancer.org

photo credit: actcancer.org

Just when you were feeling really good about being sun-savvy with your daily sunscreen use, wide-brimmed hat and love of shade, I’m here to give you a huge shout out and be your biggest cheerleader to keep it going! Being sun-smart isn’t just good for your skin, it’s good for your whole body, a point reiterated by a recent study published by researchers from the Brigham and Women’s Hospital and Harvard Medical School.

This current study supports and expands upon findings of previous work which shows that people who have had non-melanoma skin cancers (NMSC), specifically basal and squamous cell carcinoma, are approximately twice as likely as people without such history to develop melanoma as well as non-skin cancers including cancer of the breast and lung. After researchers accounted for other potential risk factors for developing cancer, they found that a history of NMSC was associated with an 11% higher risk of other primary cancers (including lung cancer) in men and a 20% higher risk of other primary cancers (including breast cancer) in women. Moreover, they found that having NMSC had about twice the risk of developing melanoma in both men and women (melanoma, like NMSC, is linked to overexposure to UV light). These findings are significant because NMSC is the most common malignancy, with nearly 3 million cases diagnosed annually in the United States. To break it down further, it’s estimated that one in five Americans will develop NMSC at some point in their lives and 90 percent of these cancers are associated with exposure to the sun’s harmful ultraviolet (UV) radiation.

The full implications of this research are not yet known, and while further research needs to be done to determine if there may be a genetic link between the development of cutaneous and non-cutaneous malignancies, the findings at least serve as a reminder to minimize our preventable risk for skin cancer (shout out for hats, sunglasses, sunscreen, protective clothing and shade) and to have a skin cancer screening performed by dermatologist.

There is no time like the present! May is skin cancer awareness month. Mark your calendars for Monday May 6th which is Melanoma Monday. The American Academy of Dermatology and my dermatology colleagues across the country will be hosting free skin cancer screenings that day and throughout the coming months. Women’s Dermatologic Society also has their fantastic Coast to Coast Sun Safety and Skin Cancer screening events throughout the year. I have participated in some of these events and they are great. Check out these sites to find an event near you!

Just remember, I’m here to cheer you on while you get sun-smart, sun-savvy and shade-sational! (Yes, I know that isn’t a word, but I got a little carried away. I can’t help myself).