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Skin Cancer Update - Part 2

• Over half of all new cancers are skin cancers

• More than 1 million new cases of skin cancer will be diagnosed in the United States this year*

• About 79% of new skin cancer cases are basal cell carcinoma, 15% are squamous cell carcinoma and 5% are invasive melanoma. The remaining 1% represent rare types of skin cancer, such as Merkel cell carcinoma, adnexal carcinoma(s), dermatofibrosarcoma protuberans and others

• Both basal cell carcinoma and squamous cell carcinoma have a better than 95% cure rate if detected and treated early

• An estimated 10,590 people will die of skin cancer this year, 7770 from melanoma and 2820 from other skin cancers*

• There will be about 105,750 new cases of melanoma in 2005.* This is a 10% increase from 2004. At current rates, 1 in 34 Americans have a lifetime risk of developing melanoma, and 1 in 62 Americans have a lifetime risk of developing invasive melanoma.

• One person dies of melanoma every hour. In 2005, 7770 deaths will be attributed to melanoma (4910 men and 2860 women).* Older Caucasian men have the highest mortality rates from melanoma

• The incidence of melanoma more than tripled among Caucasians between 1980 and 2003

• More than 73% of skin cancer deaths are from melanoma

• Melanoma is more common than any other form of cancer among women between the ages of 25 and 29 years

• Invasive melanoma is the fifth most common cancer in men and the sixth most common cancer in women**
  
  *Source: American Cancer Society 2005 Facts and Figures. **Excluding basal cell carcinoma and squamous cell carcinoma, which together are the most common cancers in both sexes

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Skin Cancer Update

Of the approximately 10,000 people to die of skin cancer each year, nearly 2000 suffer from nonmelanoma skin cancer. The other 8000 die from malignant melanoma.

Although almost 96 % of all skin cancers diagnosed in the U.S. each year are non-melanoma skin cancers-basal cell and squamous cell carcinomas, these can be
completely cured in 95 % of cases given early detection and treatment. *Every hour a person dies of melanoma.

Melanoma causes more than twice as many deaths among men as among women and melanoma incidence has risen more than 4 % annually since 1973 - the fastest rate of incidence of any cancer.

In 2000 only 63 % of women and 54 % of men over age 18 used some form of protection against skin cancer. Tobacco smoking is an independent risk factor for squamous cell carcinoma, more than tripling its risk among current smokers.

Between 40 % and 50 % of people living to age 65 will suffer from some form of skin cancer at least once in their lifetime.

Remember that melanoma skin cancer, although usually arising from a pre-existing mole and having pigment, can suddenly arise (i.e., not from a pre-existing mole) and be skin-colored.

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A Primer on Skin Aging & Wrinkle Creams

As we grow older, the outer layer of our skin which is called the" epidermis" becomes thicker, and, as our oil glands produce less oil, our skin becomes drier & less smooth. In addition, cumulative sun or actinic damage can result in poikilodermatous changes such as blotchiness, discoloration light and/or dark spots) and age spots.

Also, the aging process causes the middle layer of the skin called the "dermis" and which contains the collagen and elastin fibers, which give structural support to the skin, to lose their elasticity. This, of course, can eventuate into loose, sagging skin, wrinkles, and a marked tendency towards easy bruisability.

Although there are many products on the market today, both prescription & over the counter, promoted as rejuvenating the skin through improving fine wrinkle lines, reducing discoloration, and restoring a more youthful look or better "light reflection," if you will, I have chosen to discuss the following:

1. Products containing vitamin A such as tretinoin ("Retin-A","Renova").These products are keratolytic or peeling agents meant to stimulate the growth of a smoother
   skin & reduce discoloration.Tazarotene marked as" Avage" and "Tazorac" is also in this family. These products are dispensed only on the physician's prescription.

2. Alpha hydroxyacids derived from fruit sugars such as glycolic acid (sugar cane), lactic acid (milk sugar), malic acid (apples), tartaric acid (grapes). Glycolic acid-
   containing products are among the most popular as skin exfoliants which help to shed old skin cells, reduce
   blackheads, reduce fine wrinkle lines & discoloration & moisturize the skin.

3. The botanical hormone called "kinetin "(marketed as" Kinerase") which helps to keep plants green & healthy by protecting them against sun damage & cellular aging. It is especially helpful for those with the most sensitive & delicate skin to increase moisture retention & reduce signs of aging. It is non-prescription & available through physicians.

4. Topical antioxidant-containing products which both improve & prevent skin damage caused by "free radicals, "molecules that injure cellular DNA. The
   better skin antioxidants also improve skin care by stimulating "fibroblasts," skin cells that produce
   collagen and elastin, thereby firming the skin and diminishing wrinkles. Skin antioxidants include:
   
        (a) Vitamin C (L-ascorbic acid), which technically is citric acid (see alphahydroxyacids above), but is also a potent antioxidant. However, when combined with acetyl tyrosine and zinc sulfate as in the product "Cellex C," it also stimulates fibroblastic activity. This
   helps reduce fine lines & wrinkles. It is non-prescription & available in doctor's offices.
        (b) Idebenone found in a non-prescription product called "Prevage," which should be available through physicians by Jan.,2005.Data have shown that this
   antioxidant moisturizes dry skin & helps to reduce fine lines & wrinkles by smoothing the skin.
        (c) Copper & peptide (a collection of amino acids)-containing products which stimulate collagen & elastin production and foster the formation of "glycosaminoglycans,(GAS)" the glue between cells which helps to thicken the dermis and thereby reduce sagging and wrinkling skin. These are also believed to increase blood vessel formation and oxygenation
   for a more youthful-looking skin, i.e., a better "light reflection," as in a child's skin". Neova,"a non-prescription product, available from physicians is an example.

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Botox

Botox has been approved for excessive underarm sweating.

About 1%-2% of the general population has sweating severe enough to interfere
with their business and social lives and the condition is equally common in men and women.

Prior to the availability of Botox to treat this condition, known medically as axillary
hyperhidrosis, patients who did not respond to topical antiperspirants had a
choice of taking pills internally called "anticholinergics," or having their sweat
nerve endings surgically cut (a procedure called "sympathectomy"). Patients could also undergo surgical removal of the axillary (underarm) sweat glands-an invasive and mutilating procedure which was often unsuccessful.

Clinical trials of botox for excessive underarm sweating have shown some
dramatic responses including several patients who have gone for more than a year without needing reinjection and some who have gone for more than 2 years.

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Melanomas

Most people think of malignant melanoma, which, of course, is the most deadly type of skin cancer and whose incidence is increasing by 5% per year, as always occurring in sun-exposed areas as a dark or blackish mole or spot. However, acral lentiginous melanoma occurs on the palms of hands and the soles of feet and can even occur beneath finger and toenails.

Amelantoic (ie, without pigment, skin colored, etc) melanoma can even resemble a wart, callous or benign thickening of the skin called a "keratosis".

Desmoplastic melanoma, which represents 1% of all melanomas and is mostly seen on the head and neck, resembles a small scar and, therefore, looks nothing like a typical melanoma. However, desmoplastic melanoma is a very deadly lesion which often invades the peripheral nervous system and can kill the patient by migrating along the nerve to the central nervous system, ie, the brain and the spinal cord.

In summary, always report skin change to your physician and get frequent checkups.

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