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.

Fountain of youth

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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!

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).

Sticks and stones….

photo credit: lyceum group

photo credit: lyceum group

Most of you know how this saying goes, but I’ve added my own spin on it so I’m giving it a whirl:

Sticks and stones may break your bones

But Sunburns can really hurt you!

For those of you who are willing to entertain my version of nursery rhymes, thank you because I’ve taken liberties to take it one step further…

I’m rubber and you’re glue

I hope what I tell you about sun safety, skin cancer and melanoma bounces off me and sticks to you!

I know what you are probably thinking. That’s so juvenile right? Maybe Dr. Barr washed down some goldfish with too many glasses of red wine. Could she be more childish?

But that is the whole point of this post…children. Your children, my children and children all over the world. Anyone with a relationship with a child (could be your best friends’ child, a niece/nephew or your own)  has experienced that undeniable instinct to protect them from harm. It doesn’t matter what form the threat of harm may take, whether it be psychological or physical, we as adults, put on our proverbial armor and prepare ourselves to defeat the perpetrator to a child’s well-being.  Somewhere along the way however, our armor got a chink in it and we have failed to adequately protect our children (let alone ourselves) from the damaging effects of the sun. Research recently presented at the American Association of Cancer Research meeting confirms our shortcomings. Although the incidence of melanoma in childhood is rare, statistics show that the frequency of children and adolescents diagnosed with melanoma is on the rise.

Data pooled from numerous U.S. cancer registries highlighted that the incidence of childhood and adolescent melanoma has increased an average of 2 percent per year spanning the time period from 1973 to 2009. Of note, girls had higher incidence rates than boys, and compared to younger children so did those aged 15-19. Similar to their adult counterparts, girls had higher rates on their lower limbs and hips, while boys had higher incidence on the face and trunk. While further research needs to be performed to determine the factors contributing to the rising incidence, we don’t have to wait for additional data to be pro-active about vigilant protection of children and adolescents from the damaging effects of UV radiation.

Wearing wide-brimmed hats, sunscreen (with re-application at least every 2 hours) and wearing UPF rated clothing (30 and above) coupled with modifying hours spent outdoors to avoid high intensity UV-radiation (currently recommended between 10a-4p but that may be hard to do, so doing your best to avoid 12-3p may be easier) are crucial steps in protecting children and adolescents more delicate skin. But that’s only part of the solution.

Artificial UV radiation sources found at tanning salons are a significant contributing factor as I touched on in my What’s the big deal post. UV radiation from tanning devices are a significant contributor to the rising rates of both non-melanoma and melanoma skin cancer.

We know that Ultraviolet A (UVA) and Ultraviolet B(UVB) rays contribute to the development of skin cancer of all types. UVB is primarily responsible for contributing to sunburns. UVA rays penetrate deeper into the skin and contribute to premature aging of the skin including: alterations in pigmentation (brown spots), fine lines, wrinkles and loss of elasticity that contributes to a leathery appearance. Together, the synergistic effect of UVA and UVB rays contribute to the development of skin cancer. Of note, an Australian-US study has demonstrated that UVA causes more genetic damage than UVB in skin cells where most skin cancers arise – the keratinocytes in the basal layer of the epidermis. This information is critical as most tanning devices emit UVA radiation.
So what’s the bottom line you ask? It’s pretty simple: don’t let kids go to tanning salons and practice sun-safe behavior every day. Being sun-safe doesn’t mean you have to stay indoors, rather it’s a lifestyle choice. Choosing clothing that protects a greater proportion of your skin, altering the times of day you pursue your outdoor activities and putting on sunscreen as part of your daily personal hygiene regimen can easily be incorporated into your daily routine.

So how does this nursery rhyme end? Here goes:
Sticks and stones can break your bones
But Sunburns can’t hurt you if you are sun-savvy!
Doesn’t rhyme but I never said I was Dr. Seuss. Cheers to finding your Shaded Bliss!

References:
1. Skin cancer foundation: skincancer.org
2. Pediatrics Vol. 131 No. 4 April 1, 2013 pp. 772 -785

Like a fine wine…..

photo credit: www.trialx.com photo credit: http://www.trialx.com
We have heard the cliché countless times, “Aged like a fine wine.” But what does that really mean? What makes a wine so fine (aside from my rhyming ability)? As with many things, success is achieved through collaboration of multiple factors to produce a better end product. The same principle applies to winemaking. The creation of a fine wine rests upon factors including the varietal of grapes used, the light, temperature and soil conditions affecting the grapes and vines respectively, the length of the fermentation process and yes, you guessed it (this is a dermatology blog after all) the skin. Wine grapes, compared to table grapes, have a thicker skin; a desirable quality as the skin imparts the aroma to wine. Grape skin also contain tannins which produce the color of the wine. These tannins found in the skin help to preserve the wine for a longer period. Recently, it has been found that the skin of black grapes (used to make red wine, a personal favorite) contain a chemical called resveratrol; which is what provides the cardio and chemo-protective health benefits of red wine.

For those of you who love wine, these tidbits are good fodder to keep drinking, yes? Salut! But the point of all this information is not really about wine of course. It’s about skin. Your skin. Like the creation of a fine wine, the health of your skin is a significant contributing factor to the end product of your overall well-being.

Your skin is the largest organ of your body. As such, it is constantly exposed to the elements just like wine grapes, and light, in the form of UV-rays have a significant impact on the quality and appearance of your skin and your health. With regards to appearance, prolonged exposure to UV-radiation directly affects the color and texture of your skin. The acute changes may be a sunburn, followed by a tanned appearance. But what about the chronic changes? Those brown spots on your arms and hands that folks refer to as “liver spots” or “age spots” are in actuality the manifestations of chronic sun exposure and resultant sun-damage. They are irreversible.

For a grape, dried by the sun, the texture and quality of the skin transforms to a wrinkled, flaccid and shriveled form which we call a raisin. Our skin is very similar to the grape. Premature wrinkling, loss of elasticity and leathery feel to the skin (think Magda from “There’s something about Mary”) are direct by-products of extensive sun-exposure. So which would you rather be, a grape or a raisin? In a society where people are paying a premium for a youthful appearance with products like Botox, dermal fillers and plastic surgery, why not save money and be pro-active: protect your skin from the sun everyday!

With regards to health, it is known that UV-radiation suppresses the immune system. Suppression of the immune system leads to cancer. It has been reported that 90% of skin cancers are induced by UV-radiation exposure. 90%! This statistic is a vital reason that I encourage you to seek shade (where your bliss awaits), wear sunscreen and protective clothing on a daily basis.

Now some of you may be thinking, what? How can that be? Maybe Dr. Barr (that’s me) has been drinking too much of that red wine, because I know that phototherapy (delivery of UVB rays in a very controlled and time limited setting) make my psoriasis better! Psoriasis (a chronic skin condition +/- joint involvement) is known to be driven by an up-regulation of aspects of the immune system…so suppression of these “jazzed up” factors so to speak, is the desired end result. This principle applies to several conditions in dermatology, but these are the exceptions not the rule, and most importantly, the exposure to UV-radiation administered in a dermatologist’s office is tightly regulated and controlled to minimize adverse effects of said exposure.

Like a fine wine, your skin will age, but there’s a big difference between chronologic aging and physiologic aging. The latter of which is accelerated significantly by extensive sun-exposure. So the choice is yours, grape or raisin…which would you rather be?

What’s the big deal?

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Skin cancer is a big deal. More than 3.5 million cases of nonmelanoma skin cancer in over two million people and over 70,000 cases of melanoma are reported each year, which makes skin cancer the most commonly diagnosed cancer the United States. This means that on an annual basis there are more new cases of skin cancer than the incidence of cancers of the breast, prostate, lung and colon combined. To break this down further, one in five Americans (one in three Caucasians) will develop skin cancer during the course of a lifetime. Bottom line…skin cancer is a big deal. In my skin cancer and sun safety basics post I go over a lot of the facts, so please refer back to it for a more in-depth discussion, and please feel free to reach out if you have any questions. Also check out skincancer.org for a wealth of great information and photos of all of the different types of skin cancers.

So if I already talked about these facts in a previous post, why am I all riled up and repeating myself you might ask? Contrary to what my kids may say (and my husband and possibly the neighbors, but who likes nosy neighbors anyway?) I have not lost my mind, but my mind is most certainly boggled. A recent study reported that greater than 27% of melanoma survivors never put on sunscreen when spending more than an hour in the sun. Researchers at Yale also found that 15.4% of skin cancer survivors rarely or never sought shade from the sun, and 2.1% used tanning beds. This is insanity. Tanning beds? Evidence from several studies has shown that exposure to UV radiation from indoor tanning beds is linked with an increased risk of melanoma, the deadliest form of skin cancer, and non-melanoma skin cancer. In fact, studies have demonstrated a 75 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning. 75 percent! This evidence is the basis for championing the passage of legislation to ban the use of tanning beds for minors (currently 33 states have restricted teen’s access to tanning beds). So if these are the facts, and people who have already been diagnosed with skin cancer have been educated about these facts, and believe me, as dermatologists we tell our patients, over and over again, then why are skin cancer patients still ignoring them? This is a dilemma. This is my dilemma and I want to help change these statistics. But I need your help to do it.

We know that protecting your skin from the damaging UVA and UVB rays of the sun is imperative to minimizing your risk of developing skin cancer. Sun protection is a multi-faceted process: practicing sun avoidance during the hottest parts of the day, seeking shade (I promise you can find bliss there), wearing sunscreen (daily and reapplying often) and wearing clothing that has a UPF rating greater than 30, are all important to keeping you safe in the sun.

Based on the staggering number of skin cancers diagnosed annually and the results of the recent study noted above, it would appear that telling people this information isn’t enough. It would appear that a cultural shift, a “shade revolution” if you will, is in order. For starters, we need to embrace vintage times, go retro…what’s old is new again. It works for current fashion trends (hello neon and leg warmers!) and toys (yes, cabbage patch kids I’m talking about you!) so why can’t we embrace the way we used to behave in the sun. Back in the day our ancestors spent plenty of time outdoors, but clothing protected the majority of their body. Being pale was in vogue, whereas having a tan was undesirable. We can do this! You don’t have to give up that Caribbean vacation or frolic on the beach, just be sun savvy! Tap into your sun-conscious and take the necessary steps to protect your skin. Together we can change the perception of what’s “hot” in the sun and you will find your shaded bliss, I promise!