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Posts for: February, 2015

By Dr. J. Michael Maloney MD FAAD
February 23, 2015
Category: Melanoma
Tags: Melanoma   Skin Cancer  

MelanomaDo you do enough to make sure that the largest organ in your body - your skin - stays free from potentially-fatal diseases and other ailments? After all, you do the same for your other vital organs - your heart, your brain, your lungs - so shouldn't your skin get the preventive treatment it needs to ensure you stay healthy, too?

At Cherry Creek Dermatology, we know it's important to get your skin checked annually, and how not doing so could up your chances for melanoma sneaking into your body undetected. The expert dermatologists on site conduct skin check-ups that determine whether or not your skin shows signs of the frightening and fast-moving skin cancer, while also offering melanoma treatments if the disease is detected.

If your dermatologist finds a mole or skin growth that might signify melanoma, they will remove a small piece of the affected tissue and evaluate it more closely to determine whether or not cancerous cells are present. This process, known as a biopsy, is especially pertinent in the case of melanoma skin cancers, which are behind roughly 75 percent of skin cancer deaths today.
 
Take a look below at some telling indicators it's time for you to get your skin checked:
  • You haven't had a check-up in a year (or more)
  • You notice a mole that has:
    • irregular borders
    • black, red, or uneven colors
    • grown in size
  • You've had a significant amount of sun exposure
To keep your skin healthy and at a low-melanoma risk before you get over to your nearest dermatologist for a skin check, make sure to wear sunscreen with an SPF of no less than 30. Reapply sunscreen often to keep your skin safe from the sun's virulent ultraviolet rays (which can directly raise your risk for melanoma) and for more radiant, youthful skin.
 
For more information on melanoma treatment and prevention in the Denver, CO, area, give one of the expert dermatologists at Cherry Creek Dermatology a call at (303) 388-5629 today for full skin relief!

By J Michael Maloney MD
February 17, 2015
Category: Health Promotion

 

Guide to Self-Screening Research shows that patients are more likely than doctors to spot a melanoma

Early detection of melanoma is essential to improve the prognosis

In its early stages, melanoma can be successfully removed and monitored by regular skin screenings. In fact, survival rates can exceed 90 percent to 95 percent in early stage melanoma. However, in its most advanced stages, melanoma can be deadly. Survival rates drop to less than 20 percent when melanoma has spread to other organs. Increase your chances of catching melanoma early by carefully examining your skin once a month.

What you'll need: a bright light, a full-length mirror, a hand mirror, two chairs or stools and a blow-dryer

Check hands, including nails. In full-length mirror, examine elbows, arms and underarms.

Examine head and face, using one or both mirrors. Use blow-dryer to inspect scalp.

Focus on neck, chest and torso. Women: check under breasts.

Use mirror to inspect back of neck, shoulders, upper arms, back, buttocks and legs.

Check legs and feet, including soles, heels, and nails. Use hand mirror to examine genitals.

 


By J Michael Maloney MD
February 17, 2015
Category: Melanoma

Melanoma Treatment

 

General Information About Melanoma

Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin).

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

  • Squamous cells: Thin, flat cells that form the top layer of the epidermis.
  • Basal cells: Round cells under the squamous cells.
  • Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun or artificial light, melanocytes make more pigment and cause the skin to darken.

The number of new cases of melanoma has been increasing over the last 40 years. Melanoma is most common in adults, but it is sometimes found in children and adolescents. (See the PDQ summary on Unusual Cancers of Childhood for more information on melanoma in children and adolescents.)

Anatomy of the skin with melanocytes; drawing shows normal skin anatomy, including the epidermis, dermis, hair follicles, sweat glands, hair shafts, veins, arteries, fatty tissue, nerves, lymph vessels, oil glands, and subcutaneous tissue. The pullout shows a close-up of the squamous cell and basal cell layers of the epidermis above the dermis with blood vessels. Melanin is shown in the cells. A melanocyte is shown in the layer of basal cells at the deepest part of the epidermis.
Anatomy of the skin, showing the epidermis, dermis, and subcutaneous tissue. Melanocytes are in the layer of basal cells at the deepest part of the epidermis.

There are different types of cancer that start in the skin.

There are two forms of skin cancer: melanoma and nonmelanoma.

Melanoma is the rarest form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). This PDQ summary is about cutaneous (skin) melanoma and melanoma that affects the mucous membranes.

The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body. (See the PDQ summary on Skin Cancer Treatment for more information on basal cell and squamous cell skin cancer.)

Melanoma can occur anywhere on the skin.

In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma forms most often on the arms and legs.

When melanoma occurs in the eye, it is called intraocular or ocular melanoma. (See the PDQ summary on Intraocular (Uveal) Melanoma Treatment for more information.)

Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for melanoma include the following:

  • Having a fair complexion, which includes the following:
    • Fair skin that freckles and burns easily, does not tan, or tans poorly.
    • Blue or green or other light-colored eyes.
    • Red or blond hair.
  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
  • Being exposed to certain factors in the environment (in the air, your home or workplace, and your food and water). Some of the environmental risk factors for melanoma are radiation, solvents, vinyl chloride, and PCBs.
  • Having a history of many blistering sunburns, especially as a child or teenager.
  • Having several large or many small moles.
  • Having a family history of unusual moles (atypical nevus syndrome).
  • Having a family or personal history of melanoma.
  • Being white.
  • Having a weakened immune system.
  • Having certain changes in the genes that are linked to melanoma.

Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.

See the PDQ summary on Skin Cancer Prevention for more information on risk factors.

Signs of melanoma include a change in the way a mole or pigmented area looks.

These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have any of the following:

  • A mole that:
    • changes in size, shape, or color.
    • has irregular edges or borders.
    • is more than one color.
    • is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
    • itches.
    • oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through).
  • A change in pigmented (colored) skin.
  • Satellite moles (new moles that grow near an existing mole).

For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.

Tests that examine the skin are used to detect (find) and diagnose melanoma.

If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help find and diagnose melanoma:

  • Skin exam: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
  • Biopsy : A procedure to remove the abnormal tissue and a small amount of normal tissue around it. A pathologist looks at the tissue under a microscope to check for cancer cells. It can be hard to tell the difference between a colored mole and an early melanoma lesion. Patients may want to have the sample of tissue checked by a second pathologist. If the abnormal mole or lesion is cancer, the sample of tissue may also be tested for certain gene changes.

It is important that abnormal areas of the skin not be shaved off or cauterized (destroyed with a hot instrument, an electric current, or a caustic substance) because cancer cells that remain may grow and spread.

See the PDQ summary on Skin Cancer Screening for more information.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The thickness of the tumor and where it is in the body.
  • How quickly the cancer cells are dividing.
  • Whether there was bleeding or ulceration of the tumor.
  • How much cancer is in the lymph nodes.
  • The number of places cancer has spread to in the body.
  • The level of lactate dehydrogenase (LDH) in the blood.
  • Whether the cancer has certain mutations (changes) in a gene called BRAF.
  • The patient’s age and general health.
 


By J Michael Maloney MD
February 16, 2015
Category: Health Promotion

 

 
 

Image not available.

Hepatitis C virus (HCV) is an infection that affects the liver.

Hepatitis C is contagious and is usually transmitted through blood. People with acute HCV, a short-term illness, usually do not have symptoms. In rare cases, acute HCV may cause fever, nausea and vomiting, and jaundice (yellowing of skin or eyes). Most people with acute HCV infection do not know they are infected, and most eventually develop chronic HCV, a long-term illness. Over time, 20% to 30% develop severe liver disease, such as cirrhosis or cancer, which can be fatal. Currently, most cases of hepatitis are newly diagnosed cases of chronic HCV among baby boomers (people born between 1945 and 1965). As a result, some health organizations have recommended that everyone in this age group be screened for HCV.

The August 13, 2014, issue of JAMA contains a review article about HCV treatment.

RISKS FOR HCV

Hepatitis C can be transmitted in the following ways, among others. Baby boomers may have been exposed many years ago by

 

  • Injecting drugs

  • Having had a blood transfusion before 1992

  • Being on dialysis

  • Being exposed as a health care worker

  • Having sexual contact with someone who has HCV

  • Getting a tattoo or body piercing with an unclean tool

 

Fewer people are being infected with HCV than previously, in part because the blood supply for transfusions is safer. Also, fewer people are injecting drugs, and those who do so are less likely to share needles.

SYMPTOMS

If you have chronic HCV infection, you may not have any symptoms. The most common symptom is feeling tired. However, the virus can affect the kidneys, skin, and other organs.

SCREENING

A blood test is used to screen for HCV. If you are found to have chronic HCV infection, your doctor may perform other tests to determine the degree of liver damage. Tests may include a liver biopsy (using a special needle, taking a small sample of cells from the liver) to help make decisions about treatment.

Baby boomers are 5 times more likely to have HCV infection than people who are younger or older. As a result, 2 government health organizations recommend that everyone in this age group receive a one-time screening for HCV, even if they have no risk factors. Talk to your doctor about your need for screening.

TREATMENT

Treatment for the most common type of chronic HCV is a combination of the drugs peginterferon; ribavirin; and boceprevir, telaprevir, or sofosbuvir. A number of additional new treatments are currently in development.

Box Section Ref ID

For More Information

Credit: Deborah Tolmach Sugerman, MSW JAMA. 2014;312(6):664. doi:10.1001/jama.2013.281899.


By J MIchael Maloney MD
February 16, 2015
Category: Skin News
Tags: measles   contagious disease  

Measles in the United States

Jill Jin, MD, MPH

JAMA. Published online February 16, 2015. doi:10.1001/jama.2015.1555
 
 
 

Measles is a very contagious and serious disease. It is also very preventable.

Measles is a viral illness that causes fever, rash, cough, runny nose, and reddened eyes. The vast majority of people who become ill with measles recover. But the virus can sometimes spread to the brain or lungs and cause severe illness or death. Babies, elderly people, and pregnant women have a higher risk of becoming severely ill from measles.

Measles is no longer naturally present (endemic) in the United States. But it can be brought into the country when people who are not vaccinated travel to and from other countries. The measles virus very easily spreads through the air through coughing and sneezing. Because the virus is so contagious, if there are clusters of people who are not vaccinated, an outbreak can easily occur.

PREVENTING MEASLES

The MMR vaccine, which is given as a shot (injection), protects against 3 different infections: measles, mumps, and rubella (German measles). It is both safe and effective. For preventing measles, 1 MMR dose works 93% of the time, and 2 doses work 97% of the time. The 3% of people who are fully vaccinated and still get measles often have a milder illness than those who were not vaccinated.

WHO SHOULD BE VACCINATED?

Currently, the US Centers for Disease Control and Prevention recommends that all children receive 2 doses of the MMR vaccine. The first dose is recommended between ages 12 and 15 months and the second dose is recommended between ages 4 and 6 years, before starting school.

Receiving the MMR vaccine is safer than becoming infected with measles. As with any vaccine, there is a small risk of an allergic reaction, which can be mild or severe. Other side effects include fever, rash, or joint pains. Pregnant women and people who have weak immune systems because of certain medical conditions should not get the MMR vaccine.

In 2011, the Institute of Medicine published a report that thoroughly studied the possible harmful effects of 8 major vaccines, including the MMR vaccine. They concluded that there was no evidence to suggest a causal relationship between the MMR vaccine and autism and that serious harmful effects from the MMR vaccine were rare. In 2014, the American Academy of Pediatrics published a review article of 67 studies that found strong evidence that the MMR vaccine is not associated with autism.

RISK OF MEASLES INFECTION

Most Americans are considered protected against, or immune to, measles, either because they were vaccinated or because they had measles before. You are considered protected against measles if

 

  • You have immunization records stating that you have received 2 doses of the MMR vaccine at any point in your life.

  • You have had a blood test confirming you have immunity against measles at any point in your life.

  • You have had a blood test confirming you had measles at any point in your life.

  • You were born before 1957.

 

If any of the above is true for you, you do not need to receive an MMR booster vaccine. You also do not need to go to the doctor for a blood test to confirm that you are immune to measles.

If you cannot find any immunization or blood test records, you can ask your doctor for a blood test to check if you are immune to measles. If the test shows that you are not immune, you should be vaccinated. If you received only 1 dose of the MMR vaccine, you should ask your doctor whether you should have a booster vaccination.

 Section Ref ID

For More Information

 

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish.

Sources: Centers for Disease Control and Prevention, Institute of Medicine, American Academy of Pediatrics




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