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.

Orange and chocolate does the body good

Image

 

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!)
IMG_2002

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.

 

Ladies, got aspirin?

photo credit: top news

photo credit: top news

Got aspirin?

Perhaps you’ve heard that adding an aspirin to your daily regimen may help prevent heart attacks, strokes and decrease incidence of cancers including lung, colon, prostate and breast (good stuff right?), but I wanted to bring your attention this recent study by the derm folks at Stanford. (click on the link above to check it out)

Ladies, this is worth a read. Researchers found that women who took a daily aspirin had a lower incidence of melanoma compared to women who did not take the drug. They also found that the risk continued to decrease the longer duration the drug was taken. The study had it’s limitations, and additional research needs to be done, but it’s something to think about. Guys….I am really hoping the additional research will include you, but it looks like this research was chivalrous, “Ladies, first.” Sorry.

It’s important to note that taking aspirin is not a safe option for everyone depending on any underlying medical conditions you may have, so please, before you start any medicine consult with your physician.

-See you in the shade

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