31 May 2018
THURSDAY, May 31, 2018 (HealthDay News) — A computer can beat even highly experienced dermatologists in spotting deadly melanomas, researchers report. The study is the latest to test the idea that “artificial intelligence” can improve medical diagnoses. Typically, it works like this: Researchers develop an algorithm using “deep learning” — where the computer system essentially mimics the brain’s neural networks. It’s exposed to a large number of images — of breast tumors, for example — and it teaches itself to recognize key features. The new study pitted a well-honed computer algorithm against 58 dermatologists, to see whether machine or humans were better at differentiating melanomas from moles. It turned out the algorithm was usually more accurate. It missed fewer melanomas, and was less likely to misdiagnose a benign mole as cancer. That does not mean computers will someday be diagnosing skin cancer, said lead researcher Dr. Holger Haenssle, of the University of Heidelberg in Germany. “I don’t think physicians will be replaced,” Haenssle said. Instead, he explained, doctors could use artificial intelligence (AI) as a tool. “In the future, AI may help physicians focus on the most suspicious skin lesions,” Haenssle said. A patient might, for instance, undergo whole-body photography (a technology that’s already available), then have those images “interpreted” by a computer algorithm. “In the next step,” Haenssle explained, “the physician may examine only those lesions labeled as ‘suspicious’ by the computer.” Doctors already do skin exams with the help of a technology called dermoscopy — where a hand-held device is used to light and magnify the skin. Haenssle said AI could again be used to help analyze those images. Dr. Mary Stevenson is an assistant professor of dermatology at NYU Langone Medical Center in New York City. She agreed that the technology is not going to replace doctors, but could serve as an “aid.” There are still questions to be answered, according to Stevenson, who was not involved in the research. For one, she said, this study focused only on differentiating melanoma from benign moles — and there is more to skin cancer diagnosis than that. For the study, Haenssle’s team recruited 58 dermatologists from 17 countries. Over half had more than five years of experience and were considered “expert” level. First, the doctors examined 100 dermoscopic images of either melanomas or harmless moles. Four weeks later, they viewed those images and were given more information about the patients — such as their age and position of the lesion on the body. That more closely reflected what doctors work with in the “real world.” In the first phase, the doctors accurately caught melanomas nearly 87 percent of the time, on average; they correctly identified moles about 71 percent of the time. The computer, however, did better: When it was tuned to have the same level of accuracy as doctors in detecting benign moles, the computer caught 95 percent of melanomas. The doctors boosted their accuracy when they also had information about the patients. They caught 89 percent of melanomas, and accurately identified benign moles about 76 percent of the time. The computer still outperformed them, though: At that same level of accuracy for catching melanoma, the computer correctly diagnosed about 83 percent of moles. Haenssle said that in some parts of Germany, doctors are already using the algorithm tested in this study — in software sold by the company FotoFinder Systems GmbH. He has received fees from the company and others that market devices for skin cancer screening. For now, traditional skin exams remain the standard of care. Stevenson said she suggests people get one head-to-toe exam to inspect the skin for suspicious growths — and then talk to their doctor about how to follow up. “I also recommend getting in front of a mirror once a month to do a self-exam,” Stevenson said. The point is to spot any changes in the size, shape or color of a mole or other dark spot on the skin. According to Stevenson, some warning signs of melanoma include asymmetry in a growth, as well as irregular borders, uneven coloring and a large diameter (larger than a pencil eraser). “When melanoma is caught early,” Stevenson said, “it is highly curable.” More information The Skin Cancer Foundation has a guide on melanoma skin cancer.
26 May 2018
SATURDAY, May 26, 2018 (HealthDay News) — Learning how to do a skin self-exam could save your life. “Skin cancer is one of the few cancers you can see with the naked eye,” said Dr. Ali Hendi, an assistant clinical professor of dermatology at Georgetown University Medical Center in Washington, D.C. “Yet sadly, many people don’t know how to be their own hero when it comes to skin cancer, including what to look for on their skin or when to see a board-certified dermatologist,” he added in an American Academy of Dermatology news release. Skin cancer is the most common cancer in the United States. One in five Americans develops skin cancer, and one person dies every hour from melanoma, the deadliest form of the disease. To check your skin, use a full-length mirror to examine your entire body, front and back. Then, raise your arms and look at your right and left sides, Hendi said. Bend your elbows and carefully check your forearms, underarms and palms. Look at the backs of your legs and feet, between your toes, and the soles of your feet. With nail polish removed, check your fingernails and toenails, as well. Use a hand mirror to check the back of your neck and scalp, and part your hair for a closer look. Finally, check your back and buttocks with a hand mirror. Ask a partner to help check your back and other hard-to-see areas. “While performing a skin self-exam, keep in mind that skin cancer can develop anywhere on the skin, not just in areas that are exposed to the sun,” Hendi said. “If you notice any new spots on your skin, scalp or nails, spots that look different from other spots on your body, or spots that are changing, itching or bleeding, make an appointment to see a board-certified dermatologist,” he advised. Hendi also explained the ABCDEs of checking for melanoma. A is for Asymmetry: One half of a spot is unlike the other half. B is for Border: The spot has an irregular, scalloped or poorly defined edge. C is for Color: Colors vary from one area of the spot to another, from shades of tan, brown or black, for instance, or areas of white, red or blue. D is for Diameter: When diagnosed, melanomas are usually larger than 6 millimeters (about the size of a pencil eraser), but can be smaller. E is for Evolving: The spot looks different or is changing in size, shape or color. See a medical professional if you have any of these signs or notice an existing mole start to change in any way. “When detected early, skin cancer, including melanoma, is highly treatable, making it imperative to check your skin regularly,” Hendi said. “It only takes a few minutes to check your skin, and it could save your life.” More information The U.S. National Cancer Institute has more on skin cancer.
24 May 2018
THURSDAY, May 24, 2018 (HealthDay News) — For U.S. military personnel, deployment carries many dangers. And besides the well-known threats they face, these men and women are also at a higher-than-average risk for skin cancer, including potentially deadly melanoma, a new research review suggests. Two military groups face a particularly high risk: white service members and men over 50, according to the report. “From the Pacific Theater in World War II to more recent campaigns in Iraq and Afghanistan, U.S. military members have been deployed to areas where they face prolonged exposure to the sun’s harmful UV rays,” said study author and dermatologist Dr. Jennifer Powers. “This exposure is even more intense for those serving in desert environments because the sun’s rays reflect off of sand,” she added in a news release from the American Academy of Dermatology (AAD). For the new report, the researchers analyzed nine prior studies. Both active-duty and retired personnel face an increased risk of skin cancer, the findings showed. One reason those who serve are at greater risk: Sun protection is not a priority in the military, the researchers said. That means wearing protective clothing (apart from uniform requirements) is not the norm. Nor is sunscreen use, the researchers said. Although service members may not be able to reduce their risk of sun exposure during deployment, they can take steps to detect skin cancer early, when it’s most treatable, according to the news release. The AAD recommends you check your skin (with or without a partner) to look for possible signs of skin cancer, and to visit a dermatologist if you see suspicious spotting, itching or bleeding. The report was published in the June issue of the Journal of the American Academy of Dermatology. More information There’s more on skin cancer at the American Academy of Dermatology.
22 May 2018
TUESDAY, May 22, 2018 (HealthDay News) — If you think popping a pill will somehow keep your skin safe while you tan, think again. The U.S. Food and Drug Administration on Tuesday issued warning letters to companies marketing supplements that they claim will counter the effects of the sun’s harmful ultraviolet (UV) rays. “We’ve found products purporting to provide protection from the sun that aren’t delivering the advertised benefits. Instead they’re misleading consumers, and putting people at risk,” FDA Commissioner Dr. Scott Gottlieb said in an agency news release. The FDA sent warning letters to “companies illegally marketing pills and capsules labeled as dietary supplements that make unproven drug claims about protecting consumers from the harms that come from sun exposure without meeting the FDA’s standards for safety and effectiveness,” Gottlieb said. “There’s no pill or capsule that can replace your sunscreen,” he added. The announcement comes just ahead of Friday — Don’t Fry Day. No, it’s not a typo. The National Council on Skin Cancer Prevention has made the designation in its push to better educate Americans about skin cancer — the most common malignancy in the United States … and the most preventable. An estimated one in five Americans is at risk of developing skin cancer in his or her lifetime. Exposure to natural and artificial UV light is the biggest risk factor for skin cancer, regardless of your age or skin type, the FDA noted. Most cases of the deadliest form of skin cancer — melanoma — can be traced to too much exposure to UV light, whether from the sun or indoor tanning beds. And the effects of exposure are cumulative, adding up over the course of your lifetime. So, Gottlieb on Tuesday outlined some of his agency’s actions to keep Americans safe from the harmful effects of sun exposure, and to ensure the long-term safety and benefits of sunscreens. Many of the protective measures are obvious — such as wearing appropriate clothing, avoiding the sun from mid-morning to mid-afternoon, and seeking shade. Another FDA goal, Gottlieb said, is encouraging manufacturers to conduct research on additional active ingredients in sunscreens. He noted that people are using sunscreens far more frequently than in past decades. “When sunscreens first came on the market, they were used only occasionally at the beach. Now, people are encouraged to use them liberally whenever they are out in the sun. So our exposure to sunscreens has greatly increased,” he explained. Also of interest is how the active ingredients in sunscreens may be absorbed through the skin. When sunscreens first hit the U.S. market, the “active ingredients were not thought to penetrate the skin. We now have evidence that it’s possible for some sunscreen active ingredients to be absorbed through the skin,” Gottlieb said. “This combination of a large increase in the amount and frequency of sunscreen usage, together with advances in scientific understanding and safety evaluation methods, has given rise to new questions about what information is necessary and available to support general recognition of the safety and effectiveness of active ingredients for use in over-the-counter sunscreens,” he stated. Use the upcoming Don’t Fry Day to remind yourself of the risks posed by harmful UV radiation, Gottlieb said. More information For guidance on how to select a sunscreen, visit the American Academy of Dermatology.
13 May 2018
SUNDAY, May 13, 2018 (HealthDay News) — Sun damage puts children and teens at risk for deadly melanoma, so parents need to protect their youngsters from the sun and teach them about sun safety, oncologists say. “Don’t assume children cannot get skin cancer because of their age,” said Dr. Alberto Pappo, director of the solid tumor division at St. Jude Children’s Research Hospital in Memphis, Tenn. “Unlike other cancers, the conventional melanoma that we see mostly in adolescents behaves the same as it does in adults,” he explained in a hospital news release. “And although rare, melanoma is the most common type of skin cancer in younger patients and affects mostly teenagers. Children are not immune from extreme sun damage; parents should start sun protection early and make it a habit for life,” Pappo said. About 76,700 new cases of melanoma are diagnosed in the United States each year. Melanoma is most common in whites, occurring five times more often than in Hispanics and 20 times more often than in blacks. About 7 percent of cancers in youths aged 15 to 19 are melanomas. Parents should monitor their children for these signs: a mole that changes, grows or doesn’t go away; an odd-shaped or large mole; a pale-colored or red bump; a mole or bump that itches or bleeds. More information The American Cancer Society has more on melanoma.
02 May 2018
WEDNESDAY, May 2, 2018 (HealthDay News) — Many millennials and young people continue to tan, despite warnings about the link between excess sun exposure and skin cancer, new research warns. Some are poorly informed about the potential harms of bronzed or burned skin. Others overlook safety concerns, often driven by low self-esteem or narcissism, said study lead author Amy Watson. Many young people make tanning decisions “based on emotions and feelings, rather than logic and reason,” said Watson, an assistant professor of marketing at Oregon State University-Cascades. Skin cancer is the most common cancer in the world. And melanoma, the deadliest form, increased 800 percent among U.S. women ages 18 to 39 from 1970 to 2009, the study authors said in background notes. Watson and her team sought to assess the impact of a 2012 U.S. Food and Drug Administration requirement that sunscreen bottles carry sun-safety and health-risk information. They surveyed 250 male and female college students at a university in the southwestern United States. Most participants were between ages 18 and 23. “Our investigation revealed that the FDA’s attempt to decrease dangerous tanning behavior through the use of a Drug Facts Panel is ineffective,” Watson said. “Not only has the panel not led to higher knowledge among the most at-risk group of tanners, even if it had, we demonstrated that more knowledge does not lead to lower addictive tanning levels,” she said. Fortunately, Watson said, there has been a general decrease in indoor tanning, while outdoor tanning has held more or less steady. “The downside is that the smaller group of consumers still using tanning beds use them with alarming frequency,” she noted. Survey participants were asked 11 sun-safety questions, such as how often to wear sunscreen and how to correctly interpret SPF (sun protection factor) standards. On average, respondents got about half the answers wrong. Seven in 10 said they tanned, and about one-third said tanning was important. More than one-third said tanning made them feel better, and 4 in 10 said it boosted confidence. The researchers found that those who struggled with low self-esteem, as well as those who displayed high levels of narcissism, were more likely to be addicted to tanning. These participants said they would skip obligations in order to tan; continue to tan despite being aware of the risks; and that they were unable to stop tanning despite having tried. The findings, said Watson, argue for a new approach to reach young tanning holdouts. Telling people what they should and shouldn’t do — use sunscreen/wear sun protective clothing/stay indoors — isn’t working, she said. Instead, “we need to change the meaning of tan skin from being a ‘healthy glow’ to the reality that it is damaged skin,” Watson said. “Once consumers view tanned skin as damaged skin, they will begin to seek preventative methods,” she added. Dr. Joann Elmore is a professor of medicine with the David Geffen School of Medicine at the University of California, Los Angeles. She shared that sentiment. “Beauty standards have always been influenced by the social, cultural and historical periods,” she said. “We need an effective way to demonstrate to young people the ‘why’ of protecting our skin and modifying tanning behavior,” Elmore added. “The younger generation may not respond as well to the public service announcement style that was effective a generation ago. They now find and search for their information on social media, therefore, we need to do outreach on those platforms,” she said. The key to reaching college kids might be to catch them when they’re younger, said Ashani Weeraratna, a professor with the Melanoma Research Center at the Wistar Institute in Philadelphia. “Australia has managed to decrease rates of skin cancer through an aggressive campaign that begins in elementary school,” Weeraratna said. “If we could do the same here, rather than expose our kids to shows like the ‘Jersey Shore’ that actually encourage tanning, we would be much better off,” she said. The study was published recently in the Journal of Consumer Affairs. More information There’s more on the dangers of tanning at the U.S. Centers for Disease Control and Prevention.
27 April 2018
FRIDAY, April 27, 2018 (HealthDay News) — Construction workers, farmers and others who work in the sun are at greater risk for skin cancer, according to researchers. And a new study reveals these job-related cancers cost nations millions in medical expenses. The researchers said lawmakers should address this trend and take steps to reduce job-related exposure to the sun’s harmful ultraviolet rays. “The findings suggest that policymakers might give greater priority to reducing sun exposure at work by allocating occupational cancer prevention resources accordingly,” said lead investigator Emile Tompa, a senior scientist at the Institute of Work and Health in Toronto. Tompa and his team analyzed government records and health surveys in Canada. They found that in 2011, nonmelanoma skin cancers cost $34.6 million in Canadian dollars. (At current conversion rates, that’s about $27 million U.S. dollars.) These costs included treatment, missed work, out-of-pocket expenses and reduced quality of life. The researchers then looked at the cost per patient for nonmelanoma skin cancers. They found basal cell skin cancers cost $5,760 per person, while squamous cell carcinoma can exceed $10,500 (in Canadian currency). The study was published April 26 in the Journal of Occupational and Environmental Hygiene. “The results can also raise awareness among policymakers, employers, unions and workers about the significant contribution of workplace sun exposure to skin cancers,” Tompa said in a journal news release. “These groups can now make a strong cost-benefit argument for inexpensive exposure reduction interventions, such as shade structures, hats and loose clothing, sunscreen, and shift scheduling to reduce the amount of time workers spend in the sun,” he said. More information The American Cancer Society provides more on skin cancer.
18 April 2018
WEDNESDAY, April 18, 2018 (HealthDay News) — A walk down the aisle may be a healthy step to better skin cancer detection. New research shows that simply by being married, people increase their odds that a melanoma — the most deadly form of skin cancer — will be spotted early, when it’s most treatable. The reason? A husband or wife may help “by assisting in identification of pigmented lesions that may have otherwise gone unnoticed,” according to a team led by Cimarron Sharon, of the Hospital of the University of Pennsylvania, in Philadelphia. The finding could have implications for skin cancer prevention, the researchers said. “Clinicians may, for instance, recommend that unmarried patients initiate regular skin examinations at an earlier age and continue them more frequently to detect lesions at an earlier stage,” the study authors reported. One expert said that especially includes older men who’ve lost a spouse. “It has long been observed that many widowers do not take care of themselves or seek screening exams, and more consideration should be given to these patients in the future to prevent fatal outcomes,” said Dr. Michele Green, a dermatologist at Lenox Hill Hospital in New York City. In the study, the Philadelphia researchers tracked data from more than 52,000 people in the United States who were diagnosed with a melanoma from 2010 through 2014. Married patients were more likely to be diagnosed with early stage melanoma than those who were never married, divorced or widowed, the study found. For example, while almost half (about 46 percent) of married patients presented with a very treatable, early stage melanoma lesion, that number fell to 43 percent for patients who’d never married, 39 percent for divorced patients, and 32 percent for widowed patients, the findings showed. And the percentage of widowed patients whose melanoma was spotted at an advanced stage was triple that of married patients — just over 9 percent versus 3 percent, respectively. Married patients were also more likely to follow skin cancer treatment guidelines and get a biopsy done after detection, compared to people who weren’t married, the researchers said. The study couldn’t prove cause and effect, but Green believes the research “is very important, since it shows that having a partner — in this case a married spouse — can detect this deadly disease early before it metastasizes.” Dr. Victoria Sharon directs dermato-oncology at Northwell Health in Great Neck, N.Y. She agreed that “a spouse may not only detect suspicious lesions on his or her partner, but may also provide encouragement to seek medical attention for such lesions. They may also provide more emotional, financial, and physical support for patients to follow through with [care].” The study was published online April 18 in the journal JAMA Dermatology. More information The American Cancer Society has more on how to spot skin cancer.
16 April 2018
MONDAY, April 16, 2018 (HealthDay News) — Taking the drug Keytruda after surgery for advanced melanoma significantly reduced patients’ risk of their cancer returning, a new study found. Last May, Keytruda (pembrolizumab) became the first ever drug approved by the U.S. Food and Drug Administration to fight cancers based on specific tumor genetics, rather than where in the body the tumor occurs. The drug also gained attention after former President Jimmy Carter announced in 2015 that Keytruda had beaten back his brain cancer. But would it work against advanced melanomas, the deadliest of skin cancers? “Melanoma has always been considered an ‘outlier’ cancer in that it does not respond well to classical chemotherapy used for other cancers,” noted one specialist, dermatologist Dr. Doris Day, of Lenox Hill Hospital in New York City. She was not involved in the new study. Day said that “immunomodulating drugs [such as Keytruda] have taken melanoma from a deadly diagnosis to a cancer where we have greater and greater success with long term control and even cure.” The new study was funded by Keytruda’s maker, Merck, and included more than 1,000 patients with stage 3 melanoma. All had undergone a complete surgical removal of their tumors, but they were at high risk of a cancer recurrence. Patients were randomly assigned to take either a 200-milligram dose of Keytruda every three weeks for a year (total of 18 doses), or a placebo. After a median follow-up of 15 months, 135 of the 514 patients in the Keytruda group had been diagnosed with recurrent melanoma or had died, compared to 216 of the 505 patients in the placebo group. The 12-month survival rate without any sign of cancer’s return was about 75 percent for patients in the Keytruda group and 61 percent for those in the placebo group. That meant that statistically speaking, those in the Keytruda group were 43 percent less likely to have recurrent melanoma, the researchers said. The findings were presented Sunday at the annual meeting of the American Association for Cancer Research (AACR) and they were simultaneously published in the New England Journal of Medicine. “Patients with stage 3 melanoma have metastatic disease in one or more regional lymph nodes,” said researcher Dr. Alexander Eggermont, director general of Gustave Roussy Cancer Campus Grand Paris in Villejuif, France. “A patient’s risk of recurrence depends on the number of lymph nodes affected and the tumor load,” he explained in an AACR news release. “Those classified as having a high risk of recurrence have one or more regional lymph nodes with melanoma metastasis [spread].” Keytruda belongs to a class of drugs called PD1 inhibitors, which work by targeting a cellular pathway that helps the body’s own immune system attack the cancer cells. The drug targets tumors with DNA known as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR). These gene abnormalities affect repair mechanisms inside the cell. One expert in caring for melanoma patients said Keytruda could be a breakthrough treatment. “PD1 inhibitors are part of a class of medications called checkpoint inhibitors, and I cannot overstate the value of these new agents for the treatment of metastatic melanoma,” said Dr. Craig Devoe. He’s acting chief of hematology and medical oncology at Northwell Health Cancer Institute in Lake Success, N.Y. “This study further supports the use of this class of medications in the preventative setting,” said Devoe, who wasn’t connected to the study. He also noted that there are relatively few side effects with these medications. But there is one drawback. “A major concern is the very high cost of these agents to patients and society,” Devoe said, with a typical course of treatment costing more than $150,000. Currently, the PD1 drugs Yervoy (ipilimumab) and Opdivo (nivolumab) are approved in the United States for treatment of patients with high-risk stage 3 melanoma that has been completely removed by surgery. “We hope that these data will lead to regulators in the United States and Europe approving pembrolizumab as a new treatment option for these patients,” Eggermont said. For her part, Day said the new findings are encouraging, but “the test will be maintaining results and learning how to combine the drugs in order to minimize resistance and increase cure rates.” More information The U.S. National Cancer Institute has more on melanoma.