SKIN CANCER NEWS RELEASES

According to an article published in the Journal of Nutrition, antioxidants consumed in supplement form appear to be associated with an increase in the rate of skin cancer among women but not men.

Results from recent studies have clearly demonstrated a link between diet and risks of various types of cancers. Researchers are now focusing on clarifying precise associations between specific dietary habits and risks of different types of cancers. Ultimately, understanding these associations may help to prevent a significant portion of cancers altogether. More evidence, for example, is indicating a reduction in cancers with increased consumption of fruits and vegetables compared with meat or processed foods. However, nutrients found in fruits and vegetables that are consumed in supplement form do not appear to provide the same protective effects against the development of cancers.

Recent research into a link between diet and cancer development and prevention has included skin cancer. There are three main types of skin cancer; each is differentiated by the type of cell within the skin where the cancer originates. Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancers but are the least aggressive. Melanoma is the deadliest type of skin cancer.

Researchers from France recently conducted a study to evaluate a potential link between antioxidant vitamins and minerals and rates of skin cancer. This study included 7,876 women and 5,141 men; participants received either an oral capsule of antioxidants including vitamin C, vitamin E, beta-carotene, selenium and zinc, or a placebo (sugar pill) daily. The median follow-up was 7.5 years.

Among women the overall incidence of skin cancer was significantly increased among those who took antioxidant capsules compared with those who received placebo.
Daily supplementation did not affect the rates of skin cancer among men.

The researchers concluded that antioxidant supplementation is associated with an increased rate of skin cancer among women but not men. These results provide further data that supplementation does not appear to help prevent cancers. Rather, a diet rich with fruit and vegetables appears to provide the greatest overall protection. In regards to risks of skin cancer, diet needs to be further evaluated in clinical studies.

Reference: Hercberg S, Ezzedine K, Guinot C, et al. Antioxidant supplementation increases the risk of skin cancers in women but not in men. Journal of Nutrition. 2007; 137:2098-2105.

Biologic Therapy for Rheumatoid Arthritis Linked with Increased Risk of Skin Cancer

According to the results of a study published in Arthritis and Rheumatism, treatment of rheumatoid arthritis with drugs such as Remicade® (infliximab) or Enbrel® (etanercept) may increase the risk of skin cancer but does not appear to increase the risk of other types of cancer.

Rheumatoid arthritis is an autoimmune disease that causes pain, swelling, stiffness, and loss of function in the joints. Patients with rheumatoid arthritis have been reported to have an increased risk of cancers such as lung cancer, skin cancer, and leukemia or lymphoma, and a decreased risk of breast cancer and colon cancer.

Among patients with rheumatoid arthritis, risk of cancer may be influenced not only by the rheumatoid arthritis itself, but also by the drugs used to manage the condition. To explore the effects on cancer risk of a type of rheumatoid arthritis treatment known as biologic therapy, researchers conducted a study among more than 13,000 individuals with rheumatoid arthritis. The risk of cancer among individuals who had used biologic therapy was compared to the risk of cancer among those who had not used biologic therapy.

Biologic therapy drugs included Remicade® (infliximab), Enbrel® (etanercept), Humira® (adalimumab), and Kineret® (anakinra).

Use of biologic therapy increased the risk of nonmelanoma skin cancer (such as basal cell carcinoma or squamous cell carcinoma) by roughly 50%.
Use of biologic therapy also appeared to increase the risk of melanoma, but this result was not statistically significant; this means that the result could have occurred by chance.
Risk of other cancers was similar among users and nonusers of biologic therapy.

The researchers conclude that biologic therapy for rheumatoid arthritis may increase the risk of skin cancer but does not appear to increase the risk of other types of cancer.

Don’t Rely Solely on Sunscreen to Protect Your Skin

According to an article published in The Lancet, the best ways to protect your skin from the sun are to wear sun-protective clothing and hats and to minimize your time in the sun. Sunscreen can play a role in sun protection, but it must be used correctly and should not be used to extend your time in the sun.

Each year more than one million new cases of skin cancer are diagnosed in the United States.[1] Skin cancer is often divided into two broad categories: melanoma and non-melanoma. Melanoma is less common than non-melanoma skin cancer, but tends to be much more aggressive. Non-melanoma skin cancer refers to several different types of skin cancer, but the most common types are basal cell carcinoma and squamous cell carcinoma.

An alarming trend in both melanoma and nonmelanoma skin cancers is that the frequency of these cancers is increasing—including the frequency in children and young adults.[2],[3]

Sun exposure contributes to both melanoma and non-melanoma skin cancer, and sun protection over the course of a lifetime is the most important aspect of skin cancer prevention. An article published in The Lancet recently reviewed the best approaches to sun protection, and made the following points:[4]

The best approach to protecting yourself from the sun is to avoid the sun, especially during the middle of the day.
Clothing and hats can provide good protection, but the degree of protection varies with the fabric. Clothing that is tightly woven and thicker provides greater protection.
Sunscreen has been shown to reduce the risk of nonmelanoma skin cancer, but it’s still uncertain whether it reduces the risk of melanoma.
Most people do not apply enough sunscreen; apply it liberally to get the maximum possible benefit, and reapply regularly. It’s also important to apply it evenly, and to apply it before you go out in the sun.
Look for a sunscreen that provides protection against both UVB and UVA.
Do not use sunscreen to extend your time in the sun.

When you do need to spend time in intense sunlight, the article notes “the use of clothing over as much of the skin surface as possible, and proper application of a highly protective sunscreen over the remainder of the exposed skin, is very effective.”

FDA Approves New Over-the-counter Sunscreen Product

The U.S. Food and Drug Administration (FDA) has approved Anthelios SX, a sunscreen from L'Oreal, to be sold over-the-counter (OTC) for the prevention of sunburn and for protection against ultraviolet B (UVB) and ultraviolet A (UVA) rays. It has a sun protection factor (SPF) of 15.

UVB exposure is associated with sunburn, and UVA is a deeper penetrating form of radiation. UVA exposure is suspected to be linked to skin cancers, including melanoma. Sunscreens are thought to be important in preventing sun-induced skin cancers. Anthelios SX may more effectively block UVA than current products available in the U.S.

According to the FDA Web site (www.fda.gov), Anthelios SX sunscreen contains a combination of ecamsule, avobenzone, and octocrylene. Ecamsule has not been marketed in the U.S, but has been marketed in Europe and Canada as Mexoryl SX since 1993. The other two active ingredients, avobenzone and octocrylene, are generally recognized as safe and effective under the current OTC monograph for sunscreens.

Information on the FDA Web site states that safety and efficacy data for Anthelios SX included information from 28 studies in over 2500 patients. The most common side effects in patients were acne, dermatitis, dry skin, eczema, abnormal redness, itching, skin discomfort, and sunburn.

Anthelios SX will be available in the fall of 2006 in select pharmacies as well as physicians’ offices. Patients may wish to speak with their physician regarding the use of Anthelios SX.

High-Fat Diet Not Associated with Increase in Skin Cancer

According to an article recently published in BMC Cancer, high levels of dietary fat do not increase the risk of developing skin cancer and may, in fact, have a protective effect against its development.

There are three main types of skin cancer: melanoma, squamous cell carcinoma, and basal cell carcinoma. Melanoma is by far the most aggressive and deadly of the skin cancers; however, squamous and basal cell carcinomas are more common among the public.

Continuing research seeks to identify the influence of diet on the development of specific cancers. Results from extensive data have indicated that diets high in fruit and vegetables may reduce the risk of several different types of cancers. Since there have been mixed results on the association between dietary fat and the risk of developing skin cancer, researchers from Australia recently conducted two studies to further evaluate the potential relationship between diet and skin cancer.

The first study included 652 patients with melanoma, basal cell carcinoma, or squamous cell carcinoma and 471 individuals who were healthy. The participants in the study answered extensive questions about their fat intake. The second study followed participants for 56 to 80 months in order to document the formation of a new skin cancer.

Overall, there was no increase in the rates of any type of skin cancer among patients who consumed high levels of fat, compared to those who consumed lower levels of dietary fat.
There was actually a trend towards a decreased rate of skin cancer among patients who consumed higher amounts of dietary fat.

The researchers concluded that consumption of high amounts of dietary fat does not increase the risk of developing skin cancer and may, in fact, provide a protective benefit against these diseases. Patients should undergo regular skin screening for the early detection of skin cancer.

Reference: Robert H. Granger et al. "Association between dietary fat and skin cancer in an Australian population using case-control and cohort study designs." BMC Cancer. 2006;6:141 doi:10.1186/1471-2407-6-141.

Aldara™ Effective Against Squamous Cell Carcinoma in Situ of the Skin

According to the results of a study published in the Journal of the American Academy of Dermatology, Aldara™ (imiquimod 5% cream) effectively treats squamous cell carcinoma in situ of the skin.

More than one million new cases of skin cancer are diagnosed each year in the U.S., making it the most commonly diagnosed type of cancer.

Skin cancer is often categorized as melanoma or non-melanoma. Non-melanoma skin cancer is more common than melanoma, but tends to be less aggressive. The two most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. Squamous cell carcinoma in situ (also known as Bowen’s disease) refers to squamous cell cancer that involves only the top layer of the skin.

Aldara has been approved by the Food and Drug Administration (FDA) for the treatment of actinic keratoses (a precancerous change to the skin), as well as treatment of certain patients with small, superficial basal cell carcinoma.

Aldara is a topical medication that is applied directly to the skin. It acts as an immune response modifier, meaning that it stimulates the immune system to help fight "foreign" material, such as bacteria, viruses, and cancer cells.

To evaluate the effectiveness of Aldara in treating squamous cell carcinoma in situ, researchers conducted a clinical trial among 31 patients. Half the patients were randomly assigned to treatment with Aldara and half the patients were assigned to treatment with a placebo cream. Treatment was given daily for 16 weeks.

Squamous cell carcinoma in situ disappeared completely in 73% of the patients treated with Aldara.
None of the patients in the placebo group experienced complete disappearance of squamous cell carcinoma in situ.

The researchers conclude Aldara effectively treats squamous cell carcinoma in situ of the skin. They note, however, that additional information about optimal dosing and cost-effectiveness is needed before Aldara can become a recognized treatment for this condition.

Reference: Patel GK, Goodwin R, Chawla M et al. Imiquimod 5% Cream Monotherapy for Cutaneous Squamous Cell Carinoma in Situ (Bowen’s Disease): A Randomized, Double-Blind, Placebo-Controlled Trial. Journal of the American Academy of Dermatology. 2006;54:1025-32

Interferon May Provide Cures for Basal Cell Carcinomas

According to an article published in the Journal of the American Academy of Dermatology, injections of interferon directly into the cancer may provide cures for a large portion of patients with basal cell carcinoma.

Basal cell carcinoma is the most common form of skin cancer—it affects 800,000 Americans each year. This also makes BCC the most common cancer occurring in humans. It has been estimated that one out of every three new cancers is a skin cancer; the vast majority is basal cell carcinoma.

The number of new cases has increased each year in the last few decades, and the average age of onset of the disease has steadily lowered. And, while more men than women get basal cell carcinoma, there has been a marked increase in incidence in women.

Chronic exposure to sunlight causes almost all basal cell carcinomas, which occur most frequently on exposed parts of the body. Treatments for BCC include the surgical removal of the cancer with or without surrounding tissue, freezing of the cancer cells, radiation therapy and chemotherapy in some instances, and/or stimulating the immune system to help fight cancer.

Fortunately, BCC tends to spread very slowly. As well, cure rates are very high following surgery alone.

Researchers from Houston, Texas, recently conducted a trial to evaluate the injection of interferon, an agent that stimulates the immune system to help fight cancer, directly into the cancer in patients with BCC. This trial included 50 patients with a total of 98 BCCs. They were treated with interferon between 1985 and 1992.

At an average follow-up of 13.5 years (10 years minimum follow-up), cures were achieved in 95 of the 98 BCCs.

The researchers concluded that injection of interferon directly into BCCs may provide cures for a significant portion of patients. However, clinical trials directly comparing these injections to surgery are necessary to accurately assess interferon’s true clinical benefit.

Reference: Tucker SB, Polasek JW, Perri AJ, et al. Long-term follow-up of basal cell carcinomas treated with perilesional interferon alfa 2b as monotherapy. Journal of the American Academy of Dermatology. 2006;54:1033-1038.

Remicade® and Humira® Increase Risk of Cancer

According to an article recently published in the Journal of the American Medical Association, patients taking the rheumatoid arthritis drugs Remicade® (infliximab) or Humira® (adalimumab) had a three-fold increased risk of developing various types of cancers.

Remicade and Humira are agents referred to as anti-tumor necrosis factor (Anti-TNF) antibodies; they have demonstrated effectiveness in the treatment of severe rheumatoid arthritis. An issue surrounding these agents is that tumor necrosis factor is thought to provide protection against cancer and infection. The use of anti-TNFs that block the productivity of tumor necrosis factor has thus been associated with an increased risk of infection and possibly various types of cancers.

Researchers from the Mayo Clinical conducted a study to further evaluate the potential effects of Remicade and Humira on the incidence of cancer. The study included data from nine clinical trials that compared anti-TNF therapy to placebo (inactive substitute) in patients with rheumatoid arthritis. The studies included over 3,000 persons receiving anti-TNF therapy and over 1,500 receiving placebo (control group).

Patients taking anti-TNF therapy had over a three-fold increased risk in developing a cancer than the control group.
Patients treated with high doses of anti-TNF therapy had a 4.3-fold increased risk of developing cancer compared to the control group.
Patients treated with low doses of anti-TNF therapy had a 1.4-fold increased risk of developing cancer compared to the control group.
Types of cancers that were increased were lymphomas, skin cancer, breast cancer, lung cancer, and gastrointestinal tract cancers.
This data represents one additional cancer for every 154 patients treated with anti-TNF therapy.

The researchers concluded that treatment with anti-TNF therapy increases the risk of developing cancers, particularly among patients treated with high doses of this type of therapy. Patients undergoing treatment with anti-TNF therapy should speak with their physician regarding their individual risks and benefits of treatment.

Reference: Bongartz T, Sutton AJ, Sweeting MJ, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serous infections and malignancies. Journal of the American Medical Association. 2006;295:2275-2285.

Human Papillomavirus Infection Linked with Squamous Cell Skin Cancer

Infection with certain types of human papillomavirus (HPV) appears to increase the risk of squamous cell carcinoma of the skin but not basal cell carcinoma of the skin. These results were published in the Journal of the National Cancer Institute.

Each year, more than one million people are diagnosed with skin cancer in the US alone. Melanoma is the most aggressive type of skin cancer, but is much less common than non-melanoma skin cancer.

The two most common types of non-melanoma skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Sun exposure is thought to be the most important risk factor for both types of cancer.

Human papillomaviruses consist of a group of more than 100 different viruses. Some types of HPV cause warts on the hands or feet, other types cause genital warts, and some types have been linked with cancer, most notably cervical cancer. Researchers have speculated that there could be a link between certain types of HPV and non-melanoma skin cancer, but evidence for a link is limited.

To evaluate the link between non-melanoma skin cancer and HPV, researchers collected information from 252 patients with SCC, 525 patients with BCC, and 461 comparison subjects without skin cancer. Patients were diagnosed between 1993 and 1995 and were between the ages of 25 and 74. All subjects were tested for antibodies against 16 different types of HPV. Patients with antibodies against a specific type of HPV are considered seropositive (blood serum tests positive) for that type of HPV.

Results suggest a link between certain types of HPV and SCC:

Individuals who were seropositive for any HPV type had an increased risk of SCC, but not of BCC.
The overall risk of SCC was slightly higher among individuals who were seropositive for multiple types of HPV.
When considering different subgroups of HPV, the subgroup known as beta HPV was the one linked with SCC. This subgroup includes HPV types 5,8,9,15,20,24,36, and 38.
When individual types of beta HPV were analyzed separately, HPV 5 was the only one significantly linked with SCC. Compared to subjects who were seronegative for all beta HPVs, subjects who were seropositive for HPV 5 had an 80% increased risk of SCC.
There was no link between any of the beta HPV types and BCC.

The researchers conclude that although sun exposure and sun sensitivity are the major risk factors for SCC, infection with certain types of HPV may also play a role.

Reference: Karagas MR, Nelson HH, Sehr P et al. Human Papillomavirus Infection and Incidence of Squamous Cell and Basal Cell Carcinomas of the Skin. Journal of the National Cancer Institute. 2006;98:389-95.

Nonsteroidal Anti-Inflammatory Drugs May Prevent Actinic Keratoses and Skin Cancers

According to results recently published in the Journal of the American Academy of Dermatology, the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) may prevent the development of actinic keratosis and squamous cell cancers of the skin.

Actinic keratosis refers to a condition of precancerous areas or spots that develop on the skin, particularly among individuals who have had extensive sun exposure. Actinic keratosis has the potential to turn into a squamous cell skin cancer.

Squamous cell cancers of the skin are the second most common type of skin cancer diagnosed in the U.S. Fortunately, squamous cell cancers of the skin are easily removed by surgery and do not tend to spread, unless they become very advanced. However, due to their prevalence, researchers are evaluating ways to prevent the cancers altogether.

NSAIDs are drugs that are used to reduce inflammation and therefore pain. Aspirin and other over-the-counter drugs are readily used by a large portion of individuals. Recent research has indicated that regular use of NSAIDs may protect against some cancers; this remains an area active of investigation with several ongoing studies.

Researchers form Australia recently conducted a study to evaluate a possible association between NSAID use and squamous cell skin cancer among 1,621 sun-exposed individuals. Results indicated that individuals who regularly used NSAIDs had lower risks of cancer:

Individuals who took NSAIDs more than eight times per week for more than a year or who had taken full-dose NSAIDs two or more times per week for more than five years had a significant reduction in the risk of squamous cell cancer.
Individuals who used NSAIDs two or more times per week had a 48% reduction in the occurrence of actinic keratosis compared to individuals who did not regularly use NSAIDs.
Individuals who had the highest NSAID use had the lowest incidence of actinic keratosis.

The researchers concluded that regular NSAID use may prevent or reduce the risk of developing squamous cell skin cancers or actinic keratosis among sun-exposed individuals. Further study is necessary to confirm these findings. Prior to taking NSAIDs, patients should always speak with their physician regarding their individual risks and benefits of NSAID use.

Reference: Butler GJ, Neale R, Green AC, et al. Nonsteroidal anti-inflammatory drugs and the risk of actinic keratoses and squamous cell cancers of the skin. Journal of the American Academy of Dermatology. 2005;53:966-972.

History of Non-Melanoma Skin Cancer Increases Risk of Melanoma

According to a study published in the journal Cancer, postmenopausal women with a history of non-melanoma skin cancer have a roughly 70% greater risk of developing melanoma than women without such a history.

Basal cell carcinomas account for a majority of skin cancers in both men and women. Basal cell carcinomas are slow growing and most commonly appear on sun-exposed areas of the skin. Squamous cell carcinomas are less common than basal cell carcinomas and tend to be more aggressive. Like basal cell carcinomas, squamous cell carcinomas tend to appear on sun-exposed skin.

Melanoma is a type of skin cancer that can be quite deadly once it has spread beyond the site of origin. However, this disease is highly curable when caught and treated prior to spread. Individuals with fair skin, freckles, a strong family history of melanoma, or those who have spent significant time unprotected in the sun are advised to visit a dermatologist regularly for melanoma screening so that the cancer may be caught and treated as early as possible.

To evaluate the risk of melanoma among women with and without a history of non-melanoma skin cancer, researchers analyzed information from the Women’s Health Initiative Observational Study. Between 1994 and 1998, the study enrolled 93,676 postmenopausal women from around the U.S. The current analysis focuses on the 67,030 women of non-Hispanic white race who had no history of cancer other than non-melanoma skin cancer. A history of non-melanoma skin cancer was reported by 5552 of these women.

After an average of 6.5 years of follow-up, melanoma was uncommon, but developed more frequently in women with a history of non-melanoma skin cancer than in women with no history of non-melanoma skin cancer.

Melanoma developed in 59 of the 5552 women with a history of non-melanoma skin cancer and 272 of the 61,478 of the women without a history of non-melanoma skin cancer. This corresponds to roughly 160 cases per 100,000 women per year among those with a family history of non-melanoma skin cancer and 70 cases per 100,000 women per year among those without a family history of non-melanoma skin cancer.
After accounting for several factors that may influence the relationship between non-melanoma skin cancer and melanoma (such as age, education, smoking, body mass index, geographic region, sun exposure and family history of cancer), the risk of melanoma was 70% higher in women with a history of non-melanoma skin cancer than in women without such a history.

The researchers conclude that the link between non-melanoma skin cancer and subsequent melanoma “is important not only for further defining melanoma risk in white postmenopausal women, but also for sensitizing the medical community to this risk and for developing new routines of follow-up and patient assessment by medical providers to promote the early detection of melanoma.”

Reference: Rosenberg CA, Khandekar J, Greenland P et al. Cutaneous Melanoma in Postmenopausal Women After Nonmelanoma Skin Carcinoma. Cancer. Early online publication December 19, 2005.

Non-Melanoma Skin Cancer Increasing in Younger Adults

Rates of both basal cell carcinoma and squamous cell carcinoma have increased over time among people under the age of 40, according to a study published in the Journal of the American Medical Association (JAMA).

Skin cancer is the most common type of cancer. It is generally divided into two categories: melanoma and non-melanoma. Non-melanoma skin cancer is much more common than melanoma, but also more curable. The most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinomas account for a majority of skin cancers in both men and women. Basal cell carcinomas are slow growing and most commonly appear on sun-exposed areas of the skin. Squamous cell carcinomas are less common than basal cell carcinomas, and tend to be more aggressive. Like basal cell carcinomas, squamous cell carcinomas tend to appear on sun-exposed skin.

The frequency of non-melanoma skin cancer is known to be increasing in older adults, but there is less information available about skin cancer trends in younger adults. To assess trends in the frequency of non-melanoma skin cancer in younger adults, researchers conducted a study among residents under the age of 40 in Olmsted County, Minnesota. Information was collected about non-melanoma skin cancers diagnosed between 1976 and 2003. They identified a total of 451 basal cell carcinomas and 70 squamous cell carcinomas.

Between 1976 and 2003, rates of basal cell carcinoma increased significantly among women but not among men. Among women, the rate of basal cell carcinoma increased from 13 cases per 100,000 members of the population during the years 1976-1979 to 32 cases per 100,000 during 2000-2003. By comparison, the rates of basal cell carcinoma in men were 23 cases per 100,000 during 1976-1979 and 27 cases per 100,000 during 2000-2003.

Rates of squamous cell carcinoma also increased between 1976 and 2003, and the increase affected both men and women. Among men and women combined, the rate of squamous cell carcinoma increased from roughly one case per 100,000 members of the population in 1976-1979 to roughly four cases per 100,000 in 2000-2003.

In light of the increasing frequency of non-melanoma skin cancer in younger adults, the researchers emphasize the importance of skin-cancer prevention messages. Risk of non-melanoma skin cancer can be decreased by avoiding sun exposure, wearing sun-protective clothing and hats, and using sunscreen.

Reference: Christenson LJ, Borrowman TA, Vachon CM. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA. 2005;294:681-690.

Moh’s Micrographic Surgery May Be Superior to Surgical Excision for Large Basal Cell Carcinoma

According to a recent article published in the Lancet, Moh’s micrographic surgery may be superior to conventional surgical excision for large and aggressive basal cell carcinomas.

Basal cell carcinoma is typically a slow growing type of cancer that originates in the skin. Basal cell carcinoma is the most common cancer in the Caucasian population. Patients with basal cell carcinoma are usually treated with the surgical removal of the cancer and surrounding tissue, referred to as surgical excision. However, for over 60 years, an alternative approach has also been used, which is called Moh’s micrographic surgery (MMS). MMS is a form of surgery for skin cancer developed by Frederick Moh in the early 1940s. This technique includes the removal of the part of the skin that involves the cancer. The skin is removed layer by layer, with the physician evaluating each layer as it is removed to determine if the cancer is still evident. Since MMS includes the evaluation of each layer of skin, while conventional surgical excision includes arbitrary parameters surrounding the cancer, MMS tends to reduce the severity of disfigurement following the procedure. If cancer cells exist in the sample of removed skin, another layer of skin is removed. MMS has never been compared to conventional surgical excision despite widespread use.

Researchers from the Netherlands recently conducted a clinical study to compare MMS to conventional surgical excision for the treatment of large, aggressive basal cell carcinomas. This study included 95 patients who were treated with MMS and 93 patients who were treated with surgical excision. At 18 months, the rate of cancer recurrence in initial basal cell carcinoma was nearly identical between the two types of treatment: 2% for patients treated with MMS and 3% for patients treated with surgical excision. The rate of cancer recurrence in basal cell carcinomas that had already recurred were 0% for MMS and 3% for conventional excision. Defects due to treatment were increased in the group of patients treated with surgical excision compared to MMS, but the cost of MMS was approximately twice that of surgical excision.

The researchers concluded that MMS may be superior to conventional surgical excision for the treatment of basal cell carcinomas, particularly larger cancers, as surgery can produce aesthetic defects. However, overall recurrence rates were virtually identical between the two treatments, leaving no conclusive benefits of one type of treatment over the other in terms of treatment efficacy. Patients with basal cell carcinoma may wish to speak with their physician about the risks and benefits of MMS or conventional surgical excision.

Reference: Smeets NWJ, Krekels GAM, Ostertag JU, et al. Surgical excision vs. Moh’s micrographic surgery for basal-cell carcinoma of the face: randomized controlled trial. Lancet. 2004;365:1766-1771.

Aldara® Approved for Superficial Basal Cell Skin Cancer

The Food and Drug Administration recently approved the topical cream Aldara® (imiquimod) for the treatment of superficial basal cell cancer of the skin. However, this indication excludes treatment of superficial basal cell cancer that occurs on the face.

Basal cell cancer of the skin is one of the most common types of cancer. Superficial basal cell carcinoma is one type of basal cell carcinoma, and often causes scaly patches of the skin or areas of the skin that are pink to red-brown in color. Superficial basal cell carcinoma tends to occur on areas other than the face, such as the trunk, arms, legs, back or chest. Basal cell carcinoma is easily treated, particularly when diagnosed early, and has high rates of cure. Treatment often includes the surgical removal of the cancer from the skin, done on an outpatient basis. However, if basal cell carcinoma is left untreated for a lengthy period of time, significant disfigurement or cosmetic issues may occur due to extensive surgery. Fortunately, basal cell carcinoma tends not to be very aggressive and tends not to spread to vital organs and patients often do not require additional treatment following surgery. Patients already diagnosed with basal cell carcinoma should receive scheduled follow-up with a dermatologist as they may develop subsequent basal cell carcinomas in their lifetime.

Aldara® is a topical cream that is already approved for a skin condition called actinic keratosis, as well as external genital warts. Aldara® is classified as an immune response modifier, meaning it stimulates the immune system to help fight "foreign" material, such as bacteria, viruses and cancer cells. The approval of Aldara® was based on two clinical trials including over 360 patients. Patients with superficial basal cell carcinoma were treated with Aldara®, 75% of whom had no evidence of cancer following treatment upon repeat biopsies. One study included 182 patients who were followed for 2 years after finishing treatment and nearly 80% of patients had no evidence of cancer at the end of the study. Side effects of Aldara® include skin reactions at the site of treatment such as redness, swelling, peeling, itching, burning, sores or blisters.

Patients with superficial basal cell carcinoma that is not on the face may wish to speak with their physician about the risks and benefits of treatment with Aldara®.

Reference: U.S. Food and Drug Administration. FDA Approves New Use of Drug to Treat Superficial Basal Cell Carcinoma, a Type of Skin Cancer. Available at: http://www.fda.gov/bbs/topics/news/2004/NEW01088.html. Accessed July 2004.

Imiquimod 5% Cream is Effective Treatment for Basal Cell Cancer

A skin cream called Imiquimod 5% appears to eradicate basal cell cancers that only invade superficial layers of the skin, according to a recent article published in the Journal of the American Academy of Dermatology.

Basal cell cancer is the most common form of skin cancer and is an increasingly common tumor in fair-skinned populations throughout the world. Fortunately, it is a slow-growing cancer that very rarely spreads throughout the body. Basal cell cancer has a tendency to develop in persons with a light complexion that have had significant exposure to sunlight. The overall cure rate averages between 85% and 95%, depending on the extent of the disease and the type of treatment utilized. Patients with basal cell cancer are usually treated with surgery, which often has to be repeated and can leave scarring.

Imiquimod 5% is a new topical cream that is directly applied to the site of cancer and is being evaluated for the treatment of early stage basal cell cancer. Early stages of basal cell cancer only involve the superficial layer of epithelium (skin). Imiquimod 5% stimulates an immune response to the location in which it is applied. Once the immune cells infiltrate the area, they recognize the cancerous cells as foreign and initiate an attack against them.

Researchers from Australia recently conducted a multicenter clinical trial evaluating Imiquimod 5% cream in the treatment of 99 patients with superficial basal cell cancer. For a duration of 6 weeks, patients followed one of the following schedules: two applications of Imiquimod 5% every day, one application every day, 2 applications daily 3 times a week, or 1 application daily 3 times a week. Following the completion of this regimen, the treatment sites were surgically removed and examined under a microscope. Complete disappearance of cancer was achieved in 100% of patients in the twice daily regimen, 88% of patients in the once daily regimen, 73.3% of patients in the twice daily 3 times a week regimen, and 69.7% in the once daily 3 times a week regimen. Inflammatory skin reactions at the site of application were common. However, the majority of patients tolerated the treatment well, with only one patient not continuing treatment due to side effects.

These results suggest that Imiquimod 5% appears promising for the treatment of superficial basal cell cancers and may potentially allow patients to forego surgery. The physicians conducting this trial suggest that Imiquimod 5% cream may be an effective patient administered treatment option for superficial basal cell cancer. Patients with superficial basal cell cancer of the skin may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating Imiquimod 5% cream or other promising therapeutic approaches. Two sources of information about ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute ( cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. ( Journal of the American Academy of Dermatology, Vol 44, No 5, pp 807-13, 2001)

The Presence of More Than One Basal Cell Cancer at a Time Increases the Risk of Cancer Recurrence

Researchers in England claim that the presence of more than one basal cell cancer at a time increases the risk of cancer recurrence. Researchers in England evaluated over 900 patients with basal cell cancer to determine whether patients that had clustering, two or more basal cell cancers present at the same time, were associated with a higher rate of recurrence.

Basal cell cancer is the most common form of skin cancer. Fortunately, it is a slow growing cancer that very rarely spreads throughout the body. Basal cell cancer has a tendency to develop in persons with a light complexion that have had significant exposure to sunlight. The overall cure rate averages between 85% and 95%, depending on the extent of the disease and the type of treatment utilized. However, researchers have recently discovered an association between the presence of more than one basal cell cancer at the same time in a person with an increased risk of recurrence (return after treatment) of the cancer at other sites in the body.

Results from this study showed that individuals who had clustering were more likely to have recurrences of basal cell cancer than individuals who had only a single cancer present. The recurrences were not simple failures of treatment as they frequently occurred at sites distant from the original cancers. In addition, it was found that clustering occurred in older patients more often than younger patients.

From these findings, researchers suggest that patients identified with clustering of basal cell cancer should receive thorough and routine follow-ups for the early detection of any recurrences. Persons with basal cell cancer may wish to speak to their physician about follow up schedules or about their risk of developing a recurrence. ( Cancer, Vol 89, No 5, pp 970-976, 2000)

Redheads More Vulnerable to Skin Cancer - Different Melanin Type May Be the Reason

By LAURAN NEERGAARD
The Associated Press

August 29. 2005 6:27AM

WASHINGTON - Redheads sunburn easily, but that may not be the only reason they are at high risk of skin cancer. New research suggests the pigment that colors their skin may set them up for cancer-spurring sun damage even if they do not burn.

More than 1 million Americans develop some form of skin cancer each year. Among those most at risk are people with light skin, hair and eyes, a combination frequent in redheads. They are particularly prone to sunburns, a risk factor for anyone, especially if the burns occur in childhood.

Scientists long have wondered if something else plays a role in redheads' high risk. One theory focuses on melanin, the skin pigment that darkens with sun exposure to provide either a tan or freckles. People with red hair have a chemically different type of melanin than people with dark hair.

Duke University researchers yesterday reported the first direct evidence that those melanin differences indeed may be a culprit. It turns out that redheads' melanin is more vulnerable to a type of DNA-damaging stress from the sun's ultraviolet rays.

To study the question, Duke chemistry professor John Simon turned to hair.

It is very difficult to cull melanin from human skin, but the pigment is the same in hair. He bought naturally red and black hair from wig makers and, for a broader sample, offered to pay for red-haired Duke students' haircuts in return for the clippings.

Using a special laser and microscope, Simon analyzed how the pigments reacted as they absorbed either ultraviolet B rays associated with sunburn, or ultraviolet A rays, which can penetrate and damage skin even without a burn.

Both UVA and UVB light caused a photochemical reaction with the redheads' pigment, called pheomelanin. The reaction creates oxidative stress, where oxygen molecules called free radicals are formed that damage DNA and cells in ways that, over time, can accumulate to spur cancer.

In contrast, only UVB light caused that oxidative reaction with the pigment from black hair, called eumelanin, Simon reported.

His research, funded by the government and Duke, was presented at a meeting of the American Chemical Society.

"There has been speculation for years that pheomelanin could be a key pathway" in skin cancer formation, said Dr. Martin Weinstock of Brown University, a spokesman for the American Cancer Society. "The thought is that eumelanin does a reasonable job of protecting against UV and pheomelanin might in fact aggravate damage."

While more research is needed, Simon said in an interview that his study reinforces some practical advice: Slather on sunscreen that promises to protect against both UVA and UVB rays.

All sunscreens work against UVB, but it can be hard to tell how much UVA protection "broad-spectrum" ones offer. The Food and Drug Administration is working on long-delayed labeling guidelines that promise to one day help consumers figure that out.

And what about blondes? They harbor some of the same pigment as redheads, Simon said.

Coffee Reduces Skin Cancer Risk

Caffeine could stop skin cancers spreading by stopping cells dividing, or by acting as an antioxidant.

Drinking coffee can cut the risk of skin cancer by more than a third, scientists say.
Researchers found that people who drank more than six cups of caffeinated coffee a day reduced their chances of developing the most common form of skin cancer by 35 percent, while those who drank two or three cups were 12 percent less likely to have the disease.
Scientists believe caffeine could stop skin cancers spreading by stopping cells dividing, or by acting as an antioxidant, Telegraph.co.uk reported.
Cases of skin cancer have quadrupled for men and tripled for women over the past 25 years in Britain, partly because of the increase in holidays in the sun.
Around 75,000 cases of non-melanoma skin cancer (NMSC), the milder form of the disease, are diagnosed each year. Dr Ernest Abel, whose study was published in the European Journal of Cancer Prevention, said: “The decreased prevalence in non-melanoma skin cancer associated with daily consumption of caffeinated coffee was dose-related and consistent with other studies.
“Among the possible explanations for caffeine’s protective effect on NMSC are an antioxidant effect and/or inhibition of DNA synthesis and cell division.“
Dr Abel, of Wayne State University, Detroit, and colleagues compared rates of NMSC among more than 77,300 white women aged 50 and over. They excluded women of other ethnic origins as they reported much lower rates of the disease.
The researchers said the findings should apply equally to men and women of all ages. Drinking decaffeinated coffee had no effect on participants’ chances of developing skin cancer.