an independent supplement by mediaplanet to usa today no.2...

An Independent supplement by medIAplAnet to usA todAy

No.2 / May 2010

skiN safety

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tips

Risk Factors What puts people in danger

self-tanners looking tan without the risk

screenings Checking your skin thoroughly and often

www.melanoma.org(800) 673-1290

Is this the best we can do?The last time a new drug was approved for advanced melanoma was over a decade ago; 85% of people who take that drug get no benefit from it.

summer edition

It’s your skIn.

Learn how you can take care of it all year long.

We can do better. You can help.

2 · mAy 2010 An Independent supplement by medIAplAnet to usA todAy

CHaLLeNGesA recent study in the Archives of Dermatology revealed that more than two million people in the us develop over 3.5 million nonmelanoma skin cancers every year.

t his constitutes a more than 300 percent increase in skin cancer in-cidence since 1994, when rates we-re last estimated.

One person dies almost every hour from melanoma. These fi-gures confirm that skin cancer is truly an epidemic.

A survey conducted on beh-alf of the Foundation by an inde-pendent market research orga-nization showed that the mes-sages we’ve been disseminating for more than 30 years—that the harmful ultraviolet (UV) radia-tion emitted by the sun can cau-se skin cancer which can kill or disfigure—have reached many Americans. Fifty-eight percent of people surveyed said they are concerned about skin cancer, so the message, for the most part, has been heard. The message is not, however, being heeded. Ac-cording to our survey, only 11

percent of people use an SPF 15 or higher sunscreen daily and 43 percent admit they know the sun is not good for them but say they look better with a tan. In short, the appeal of vanity—or “looking better”—wins over the appeal of healthy skin.

We know that 90 percent of skin cancers are associated with ultraviolet (UV) radiation from the sun, and recently the eviden-ce supporting the link between UV-emitting tanning beds and skin cancer has increased sig-nificantly. In 2009, the Interna-tional Agency for Research on Cancer (IARC), affiliated with the World Health Organization (WHO), moved tanning beds to its highest cancer risk category and labeled them ”carcinogenic to humans.” This ranking puts tanning beds alongside other cancer-causing agents, such as asbestos, arsenic and cigarettes. This announcement was made after substantial data concluded

that first exposure to tanning beds in youth increases the risk of developing melanoma by 75 percent.

The mounting scientific evi-dence about the dangers of in-door tanning has also reached the attention of the US Food and Drug Administration (FDA), prompting a recent hearing by the FDA’s Medical Devices Advi-sory Panel to discuss increasing tanning bed regulations. After four hours of testimony from the public and other advocacy orga-nizations, the 16-member pa-nel unanimously recommended that the FDA upgrade its classifi-cation of tanning devices to bet-ter reflect the dangers they pose. This could result in a ban on use for minors.

I urge you to continue to read on to learn more about the prevention, detection and tre-atment of skin cancer. Have a happy, healthy and sun-safe summer.

perry robins, mdpresident and Founderthe skin Cancer Foundation

“...trials are an especially important option for those with melanomas...”

Clinical trialsHelping to find a solution for your-self and others.

We recommend

pAge 8

panel of experts p. 11practical advice from leading skin care specialists

skin safety 2nd edition, may 2010

Responsible for this issue:publisher: Justin [email protected]: sari Harrar, sally Wadyka, Jill Coody-smits

Country manager: Kayvan [email protected] manager: Jackie [email protected] manager: Carrie [email protected]

distributed within: usA todAy, may 2010this section was written by mediaplanet and did not involve usA todAy news or editorial departments.

pHotos: istockphoto.com unless otherwise indicated.

We make our readers succeed!

skin cancer: it’s serious!

“...90 percent of skin cancers are associated with ultraviolet (uV) radiation from the sun...”

MolliesFund-Parade 04-10 3/25/10 4:02 PM Page 1


News aNd iNsiGHts

what is skin cancer?

interview: sanjiv s. agarwala, Md

With more than 1,000,000 Ame-ricans diagnosed with skin cancer each year, chances are good that everyone knows someone affected by the disease. But “skin cancer” is a broad term, encompassing th-ree primary types of disease that form in skin tissues: basal cell car-cinoma, squamous cell carcinoma and melanoma. Fortunately, al-most all skin cancers are treated successfully, even though inciden-ce rates are on the rise.

“Most skin cancers are rare-ly lethal, particularly in their ear-liest stages,” says James Goydos, MD, associate professor of surgery at the Cancer Institute of New Jer-sey. “But sun exposure is the pri-mary cause of the disease, and we are seeing a rising number of cases

in California, Texas, Florida and even the Eastern Seaboard.”

Basal and squamous Cell Carcinoma

Basal and squamous cell carcin-omas are extremely common, ac-counting for nearly half of all can-cer diagnoses in the United States each year. Basal cell carcinomas, which account for eight of 10 skin cancers, form in the lowest lay-er of the epidermis, which is the outermost layer of the skin. It is a slow-growing disease that rare-ly spreads, though commonly re-curs following treatment.

Squamous cell carcinomas ac-count for two of 10 skin cancers, and form in the outermost layer of the epidermis. They are slightly

more prone to spreading than ba-sal cell carcinomas, though meta-stasis is uncommon.

Both basal and squamous cell skin cancers tend to form on areas such as the head and neck that are regularly exposed to the sun. Both of these cancer-types are typically found and treated early, and very few of those diagnosed will die.

melanoma Melanoma is rare, accounting

for less than five percent of all skin cancers. Still, more than 68,000 Americans were diagnosed with the disease in 2009. It forms in me-lanocytes, the very cells that pro-duce melanin, a natural sun block that normally protects skin from the harmful rays of the sun.

Unlike basal and squamous cell skin cancers, melanoma is an ag-gressive and dangerous skin can-cer if not found and treated in its earliest stages. However, it tends to be darkly pigmented on the out-side of the skin and visible to the naked eye even in its early stages, which Goydos says is good news for successful treatment.

“Because we are becoming more cognizant of melanoma lesions, almost 90 percent of all cases can effectively be treated by surgical removal.”

■■ Q: exposure to too much uV radiation from sunlight is a major risk factor for skin cancer. Beyond putting on sunscreen, how else can we protect ourselves?

■■ A: Do everything you can to prevent sunburn—and be sure your children do, too. Sun avoid-ance is important, so try to stay out of the sun between about 11 a.m. and 3 p.m. Wear a hat with a wide brim and loose clothing. The other important step is checking your skin for moles that change in shape, size, color or that begin to itch or bleed. Sixty to 70 percent of melanomas are discovered by the people who have them, so self-

exams are very important.

■■ Q: Can you describe the lasting effects of sunburn that can lead to skin cancer?

■■ A: We think part of the mech-anism is the mutation of the P-53 pathway in cells by ultraviolet rays. Normally P-53 protects against cancer, but sun damage seems to take these checkpoints away—al-lowing cancer to develop not only in places exposed to the sun but al-so, we believe, in other areas of skin that don’t receive sun exposure.

■■ Q: You’re medical director of the annual international symposium on melanoma and other Cutaneous ma-lignancies. At your recent

meeting, what new devel-opments in the detection and treatment of melano-ma stood out as especially promising?

■■ A: One of the big challenges

for physicians is knowing which moles to remove and check. New experimental techniques com-bine computer modeling and to-tal-body photography so that cli-nicians can compare images of the same mole at different times and see changes that might indicate a problem. That’s very exciting.

In the area of treatment, new drugs that target a cellular pat-hway called B-RAF look very pro-mising for advanced, metastatic melanoma. B-RAF is an important target for melanoma and in early clinical trials, experimental drugs targeting it have shrunk tumors in many patients.

Q & a

jill coody-smits

[email protected]

sari harrar

[email protected]

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Sanjiv S. Agarwala, MD, chief of oncology and hematology at St. Luke’s Cancer Center in Bethlehem, PA, is a skin cancer researcher and a physician who treats melanoma—the deadly skin cancer that’s increasing by about three percent a year in the United States. He’s passionate about cancer prevention and about advancing research to help doctors better identify and treat this disease that kills an estimated 8,650 people annually.

sAnjiV s. AgArwAlA, mdChief of oncology and Hematologyst. lukes Cancer Center

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mAy 2010 · 5An Independent supplement by medIAplAnet to usA todAy

News

spF

1Sun Protection Factor. Used to measure lotions’ ability to pro-

tect against UVB radiation.

upF

2Ultraviolet Protection Factor. Used to measure clothing’s protection

against UVB radiation.

uVA rays

3Ultraviolet A rays. Does not cause sunburn, but can cause melanoma.

uVB rays

4Ultraviolet B rays. Cau-ses sunburn, which in turn increases chances

of skin cancer.

uVC rays

5Ultraviolet C rays. Hig-hest energy UV radia-tion, but ozone blocks

it out.

useful acronyms

“Melanoma, the type of skin cancer that can be deadly, is usu-ally completely curable when caught in its earliest stages,” she says. “But once it grows deeper into the skin, it’s more likely to spread to other parts of the body. The prognosis for survival is not very good.”

The biggest factor in finding these cancers early? You—and your ability to do a simple, body-wide skin check in the privacy of your bathroom or bedroom. “We recommend people check their skin once a month,” Stein says. “It’s worthwhile seeing a derma-tologist as well for a skin check.

Depending on the results and your cancer risk, he or she may re-commend rechecks every year, or more or less often.”

Following these doctor-approved steps can help you do a thorough skin self-exam with confidence:

■■ Get naked, grab a mirror—and a friend. “You need to look every-where, even the soles of your feet, your back, and your scalp,” says David Polsky, MD, PhD director of the Pigmented Lesion Clinic at NYU. A spouse or partner can help check tough-to see areas, or use a hand mirror and a full-length mirror.

■■ Use the A-B-C-D-E method. Check your moles for any of these: A—assymetry (one side looks dif-ferent than the other); B—border (edges should be smooth); C—col-or (should be one even color); D—diameter (should be small-er than a cir-cumference of a pencil eras-er); E—evolv-

ing (look for any change, such as bleeding or itching)

■■ Report changes to your doctor. “Your dermatologist should try to see you quickly if anything turns up on a self-exam,” Stein says.

■■ Learn from your clinical skin exam. “Go home and do a self-ex-am after your clinical skin exam,” Polsky suggests. “Look at moles your doctor said were OK, so you can compare them in a month.”

■■ Map it or snap a picture. Keep track of your moles by mapping them (blank maps are available that the American Academy of Dermatology website, www.aad.org). “Or photograph moles you want to watch,” Stein suggests.

How to examine your skin:tips for you and your doctor“Catching skin cancers early makes all the diffe-rence,” says jennifer stein, md, phd, associate direc-tor of the pigmented lesion section at new York university’s langone medi-cal Center in new York City.

Backgroundsari harrar

[email protected]


News

In fact, according to the Ame-rican Academy of Dermatology (AAD), exposure to both ultravio-let A (UVA) and ultraviolet B (UVB) radiation is the most preventa-ble risk factor for all skin cancers. Each type of ray has its own effect on skin, with UVA rays responsible for tanning your skin and causing premature aging and wrinkling, and UVB rays causing sunburn. UVA rays are capable of penetra-ting glass. The good news is the-re are many easy, affordable ways

to protect your skin from the sun without avoiding the outdoors al-together. The ADA recommends the following steps for all people:

every day, cover all expo-sed skin with a water-resistant sunscreen containing a sun pro-tection factor (SPF) of at least 30.

Cover your body with pro-tective clothing, hats, sunglasses, etc., whenever possible.

opt for the shade when avai-lable, particularly between 10 am and 4 pm when the sun’s rays are most potent.

remember to apply these recommendations to children.

In addition to these preven-tive measures, the ADA warns against tanning beds and sun-lamps and suggests being extra

cautious in environments such as lakes, snowy mountains and san-dy beaches because they reflect the sun’s rays. While no one is im-mune to skin cancer, some people are more susceptible than others, so it’s important to know your per-sonal risk when you plan fun in the sun. Fair skinned people are much more susceptible to mela-noma, and Whites have a risk 10 times greater than African Ameri-cans. Family history of melanoma is also a risk factor, and individu-als with a large number of moles should have regular and thorough skin exams by a dermatologist.

fun In the sun risks and risk factors

jill coody-smits

[email protected]

■■ Question: How can you prevent skin cancer?

■■ Answer: For most people, the answer is simple and easy: protect yourself from the sun’s harmful rays.

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Questionnaire

what does sunblock con-tain that protects people?

robin Ashinoff, mdChief of mohs and laser surgery at Hackensack univer-sity medical Center; Clinical Associate professor of derma-tology at nyu medi-cal Center.

Sunblock contains physical agents that block the sun’s rays. Examples are titanium diox-ide and zinc oxide. Look for broad spectrum sunscreens, as they protect against UVA and UBV rays. They protect against UVA and UVB rays. Avoben-zene absorbs UVA rays and ren-ders them inactive. UVA rays penetrates deeper, killing im-mune cells and damaging col-lagen. UVB rays cause sunburn, blisters, and cancer because of damage to the DNA.

what should people do to protect themselves?

Wear sunscreen everyday all year-long, even during the winter. Studies show people using sun-screen on a daily basis had a low-er rate of skin cancer and looked younger than those who did not.

AVoiduV rAYsAVoidAVoidAV

uV rV rV AYsAYsAY

1tip

Children have highly sensi-tive skin and this must be accounted for.

For babies less than six months old, exposure to the sun should be avoided entirely. Once older than six months, children should use sunscreen year round. Children tend to spend more time outside

and thus are subjected to more UV radiation. Protective clothing and hats are also essential to maintain healthy skin.

It must be remembered that sunburnt skin is more likely to develop skin cancer later in life due to damage to cellular DNA, so sunburns should be avoided at all costs, at any age.

youth and the sun


News

■■ #1: go for an spF-30 or higher. The “Sun Protection Factor” (SPF) is a sunscreen’s ability to deflect the sun’s damaging rays. The hig-her the number, the longer you can stay outdoors without bur-ning—provided you use as di-rected. The catch? Protection increases only incrementally with higher numbers. An SPF-15 shields you from 93 percent of rays; an SPF-30 shields you from 97 percent. “An SPF higher than 30

may be a good idea if you burn ea-sily, but no sunscreen offers 100 percent protection,” says Willi-am D. James, MD, president of the American Academy of Dermato-logy. “It’s still important to limit time in the sun and to cover up with a hat and clothing.”

■■ #2: guard against uVB and uVA rays.Until recently, most sunscreens were formulated to filter only sunburn-causing ultraviolet-B (UVB) rays. Now, experts know that screening out UVA rays is al-so crucial; these penetrate deeper into the skin causing wrinkles, age spots and boosting skin can-cer risk. An effective sunscreen contains one or more UVA-de-flecting ingredients such as avo-benzone (Parsol 1789), ecamsule (Mexoryl SX), oxybenzone, tita-nium dioxide, or zinc oxide. “It’s easier to look for the words ’broad spectrum’ on the label,” notes Dr. James. “That means it protects against UVA and UVB.”

■■ #3: look for “water-resis-tant” on the label. Sweat and water reduce sunscreen effectiveness. “Water-

resistant” products work for up to 40 minutes in the water; “ve-ry water resistant” types last up to 80 minutes. “No sunscreen is truly water-proof, but water-resis-tant varieties extend protection a little,” James says.

■■ #4: Apply early and gene-rously. Putting on sunscreen 15 to 30 mi-nutes before you head outdoors lets ingre-dients ad-here to your skin. Use a full ounce—that’s two tablespoons’ worth. Slather every-where, including ears, back, back of legs, back of hands and—if you ha-ve one—on bald spots or areas of thinning hair. “Re-apply every two hours, soo-ner if you’ve been swim-ming or sweating,” recom-mends Dr. Alam.

Sunless self-tanning products, available as sprays, creams, and lotions from the drugstore and in the spray booths of sunless tan-

ning salons, most often contain dihydroxya-

cetone (DHA). In the four to six

hours after it’s applied, this FDA-

approved ad-ditive reacts

with amino acids on your

skin to gradu-ally darken it. Unlike tinted bronzers

that wash off, the sun-kissed color of a sunless tanner lasts several days—fading as the top layer of skin sloughs off.

For best results, shave your legs and clean skin first to remove dead cells. Apply tanner lightly and evenly. Go easy on thick dry skin, such as elbows and knees; these may soak up extra tanner and turn darker. Get help with tough to reach areas.

“Sun-bathing and tanning booths increase your risk for skin cancer and wrinkles,” says Nader Sadeghi, MD, associate professor of surgery at the George Washing-ton University School of Medicine. “It’s better to use a sunless self-tanning product. But remember to continue using sunscreen!”

Get the most from your sunscreen

sunless self-tanners: the sun-safe alternative

sari harrar

[email protected]

sari harrar

[email protected]

“lotions and gels, sprays and sticks—whatever form you choose, the right sunscreen, used the right way, helps protect against sun damage that raises skin cancer risk,” says mu-rad Alam, md, a dermato-logist and skin cancer sur-geon at northwestern me-morial Hospital in Chica-go. with dozens to choose from, here’s what you need to know about selecting and using sunscreen for maximum protection:

For a golden glow that won’t expose your skin to the sun’s harmful ultraviolet rays, grab a “tan in a can.”

GlaxoSmithKline is conducting clinical trials to examine a candidate

immunotherapy in melanoma

The DERMA TrialInvestigational immunotherapy in patients following surgical removal of lymph nodes containing melanoma. Phase III World Wide Study. More than 80 U.S. centers participating.

The PREDICT TrialInvestigational immunotherapy in some patients with melanoma not treatable by surgery. Phase II European and U.S. Study.More than 20 U.S. centers participating.

For more information go to www.gsk-asci.com or www.clinicaltrials.gov

ASCIs are investigational compounds

2010-xxx-ASCI-RecrutmentAd-USA-BAT.indd 1 13/04/10 17:12

reseArCHsunsCreens

sthereseArCH

sunsCreens

2tip


“This is a really exciting time in cancer treatment,” says Ho-ward Kaufman, MD, director of the Cancer Program, Rush Universi-ty Medical Center. “We’re making tremendous progress, and thanks to clinical trials, a large number of new drugs are being tested and receiving FDA approval.”

Finding the right trialIt can be difficult to try to navigate the confusing world of clinical tri-als on your own. “That’s why I al-ways recommend to patients that they have a coordinating physi-cian—whether it’s their oncologist or even their primary care physi-cian—look at all of the options with them,” says Kaufman. The best place to start your research is to log onto to www.clinicaltrials.gov, which is the National Cancer Insti-tute’s database of all the registered trials currently taking place.

the Best Clinical trial CandidatesWhile there are trials that enroll patients at every stage of the dis-ease, trials are an especially impor-tant option for those with melano-mas that have reached Stage III or Stage IV. “Current treatments are limited in their ability to cure later stages of melanoma,” says Joshua Zeichner, MD, director of cosmetic and clinical research, dermatolo-gy department, Mount Sinai Medi-cal Center, and a spokesperson for the Skin Cancer Foundation. “But a clinical trial will provide access to the newest medicines and combi-nations of treatments to offer hope for potential cures.”

treatments Being studiedOne of the most promising areas of research at the moment involves immunotherapy drugs. These drugs are targeted to help boost patients’ immune responses to

help their bodies recognize the foreign cancer cells and fight them off. A vaccine that helps the body target a specific antigen found in melanoma cells is currently un-dergoing a Phase III clinical tri-al. And while the results won’t be available for awhile, the results of earlier phases of trials with the drug showed great promise. Anoth-er type of immunotherapy treat-ment, known as adoptive T-cell therapy, is showing an 80 percent success rate in early studies of pa-tients with Stage IV melanoma, ac-cording to Kaufman. In the near fu-ture, expect to see stem cells play-ing a role in melanoma treatment. “Stem cells can survive tradition-al therapies and cause the cancer to come back,” says Kaufman, “so identifying them as targets and getting rid of them is an important step.”

In addition to new drugs, other therapies—and combinations of

therapies—are under investigation. Radiation treatment has improved in its ability to deliver high doses directly to the tumor with better results. Chemotherapy agents are getting better, and various trials are testing them, used in concert with other therapies. Even surgical removal of tumors has improved—and when used in combination with other therapies it can help get patients to a state of minimal disease.

“The survival curve for mela-noma is improving every year,” says Kaufman. “Thanks to the ad-vances made in clinical trials, it is becoming a controllable disease.”

News

indoor sun protectionsunshine streams through the windows of your home, office, and car. And so can ultraviolet rays that damage cells deep in your skin, in-creasing your chances for wrinkles, age spots, and even skin cancer.

The result? In a 2007 study, St. Louis University School of Medi-cine dermatologists reported that the more time people spent dri-ving their cars, the higher their risk for skin cancers—especially on the left side of the face and bo-dy, closest to a car’s windows.

Experts say anyone who spends a lot of time near windows at home

or at work may face similar risks—but that doesn’t mean pulling the curtains shut. While window glass blocks most of the sun’s ul-traviolet-B—the ones responsible for sunburns—most glass allows ultraviolet-A rays to pass through. “You can get a significant amount of UVA exposure through window glass, particularly if you drive a lot or sit in front of large windows for long periods of time on a regu-lar basis,” notes William D. James, MD, president of the American Academy of Dermatology.

Your best indoor defense? “It’s smart to wear sunscreen

every day, even if you won’t be out-

doors for very long,” Dr. James says. “A broad-spectrum sunscreen may be all the protection you need. Get in the habit of putting it on in the morning.”

there’s more you can do.In your home (and even at

work), window shades made from UVA-blocking film could help. These allow the visible spectrum of sunlight to shine in, but keep out an estimated 98 percent of UV, according to manufacturers.

Another option is to add a UVA-blocking tint or film. Available for the windows of cars and buil-dings, they’re applied to windows to filter out harmful rays. In one

Australian study, tinting car win-dows reduced UVA exposure insi-de vehicles nearly fourfold. Accor-ding to the Skin Cancer Founda-tion, transparent UVA-protective window film filters out nearly 100 percent of UVA in cars.

Tints and films for home and of-fice windows get similar results. You can buy new windows already equipped to block UVA, or add film to existing windows. Your options? Many companies manufacture and will install UVA-protective window films for you. You can also install the film yourself.

sari harrar

[email protected]

sally wadyka

[email protected]

■■ when it comes to sun safety, the right fashion accessories make a big difference. While many brands suggest sun protection is provided, not all brands are created equal. Com-panies such as Florida-based Physician Endorsed pride them-selves in offering maximum sun protection without sacrificing style. With on-trend designs, using special sunglass lenses and a collection of fashion-for-ward hats, all products are rated equal to SPF 30. Co-founder and designer for Physician Endorsed, Elissa Margulies suggests evalu-ating brands closer before trust-ing them for protection. “It is important to know your acces-sories will deliver what they claim,” said Margulies. “While some sunglasses and hats from the local retail store might pro-vide shade, they most likely do not pack the punch of maximum UV protection.” Additionally, Margulies suggests examining a brand’s website, such as www.PhysicianEndorsed.com, for information on what protection its products truly offer.

■■ Question: Are you worried that conventional cancer therapies aren’t going to be appropri-ate for your condition?

■■ Answer: then it is time to look at the myriad of clinical trials available to melanoma patients at all stages of the disease.

Harness the power of a clinical trial

paid for by pHysiCiaN eNdorsed

An investigational treatment may be able to help you fight back against Stage III or IV melanoma.

This kind of treatment, called “oncolytic immunotherapy,” is not a chemotherapy. In fact, it uses a whole different approach than any treatment that is currently available. The treatment is given by injection, and is designed to work in 2 ways:

1. Target and destroy cancer cells with little effect on healthy cells

2. Help train the body’s own immune system to identify and attack cancer cells throughout the body

It is an investigational agent, which means it has not been approved by the Food and Drug Administration (FDA) for general use.

A Phase 3 trial called OPTiM is now under way to find out how this agent may work as a treatment for advanced melanoma.

BioVexwww.BioVex.com

Learn more about the Phase 3 OPTiM trial at www.OncoVEXgmcsf.com

Wondering if you have more options to treat advanced melanoma

Copyright © BioVex 2010

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News

mohs surgeryOne of the biggest breakthroughs in the treatment of non-melano-ma skin cancers (basal cell and squamous cell carcinomas) is a procedure named after its creator Dr. Frederic E. Mohs. Although it was first pioneered more than 70 years ago, continual refinements of technique and improvements

in technology and pathology have made it the most advanced and ef-fective way to treat basal cell and squamous cell carcinomas. The procedure has up to a 99 percent cure rate for those types of skin cancers, and is sometimes also used for early stage melanomas. Traditional excision involves re-moving the tumor as well as wide margins of tissue surrounding it, but Mohs surgery allows for mo-re precise excisions that preserve more tissue. “That’s why it is most often used for tumors on the face, close to the nose, near the eye—any area that is cosmetically sen-sitive,” explains Joel Cohen, MD, Mohs surgeon and assistant clini-cal professor of dermatology at University of Colorado. A special-ly trained Mohs surgeon removes

sections of tissues, layer by layer, and then analyzes them micros-copically—continuing until the-re is no more evidence of malig-nancy.

melanoma treatmentFor Stage I and II melanomas, sur-gical excision—with wide mar-gins—is the standard of treat-ment. “And if the tumor is more than one millimeter in depth, the doctor will also perform a senti-nel node biopsy to determine if any of the melanoma cells have gone from the tumor to the re-gional lymph nodes,” explains Lynn E. Spitler, MD, director of the Northern California Mela-noma Center. For later stage can-cers, dozens of promising clinical trials are testing a variety of new

drugs—including several that are designed to boost the body’s own immune response to target and fight off cancerous cells.

non-surgical optionsPhoto dynamic therapy can be

used to treat primarily superfici-al skin cancers. But it is most often used only on those patients who—for other medical reasons—would not be good candidates for surge-ry. Topical treatments, such as Al-dera, are also mainly used for non-melanoma skin cancers caught at very early stages. “It works by edu-cating the immune system to re-cognize the sun damage antigens and fight them off,” says Cohen.

the secret is in the therapy

sari harrar

[email protected]

■■ Question: What is the best way to increase the survival rates for all types of skin cancers?

■■ Answer: seeking out doctors who have the know-how and the technology to perform the most cutting-edge treatments gives you the great-est chance to beat skin cancer.

identify melanoma early

what’s the best treat-ment for the po-tential ly d e a d l y skin can-

cer called melanoma? Finding it as soon as possible, because catching it at the early stages can lead to a nearly 100 percent cure rate. According to the Skin Cancer Foundation, approximately 68,720 new cases of melanoma will be diagnosed this year, making it the fifth most common cancer in men, and the sixth most common in women. But the good news is that while melanoma rates are rising, so are the number of can-cers caught at the least invasive stages as well as more successful, high-tech treatments for those with more advanced disease. self check for early

detection“Look for the mole that is the ‘ug-ly duckling,’ the one that is chang-ing or looks different from all the others,” says Jennifer Linder, MD, a dermatologist and Mohs skin cancer surgeon in Scottsdale, AZ and spokesperson for the Skin Cancer Foundation. Studies have shown that a mole that is chang-ing—getting bigger, changing shape, color, bleeding, or scab-bing—is the one most likely to be problematic. Do a complete, head-to-toe self check once a month, and bring anything suspicious to the attention of your derma-tologist. “When a patient has a screening done, they are 50 per-cent more likely to catch a mel-anoma at an early stage,” says Linder. “And that translates to a 20 percent decrease in mortality.”

Catch it early, cure it

quicklyThere are five stages of melano-

ma, and the first three are all con-sidered non-invasive. When the cancer is at Stage 0 (also known as melanoma in situ), the melanoma is superficial, confined to just the outer layer of skin cells. At Stag-es I and II, the tumor still has not spread beyond the skin. The dif-ference is measured by the thick-ness of the tumor—Stage I mela-nomas are less than one millime-ter thick, and Stage II melanomas are thicker than one millimeter but still confined to the immedi-ate skin tissue. “In general, before it spreads beyond the skin, the survival rate after surgery is over 90 percent,” says Joshua Zeichner, MD, director of cosmetic and clin-ical research, dermatology depart-ment, Mount Sinai Medical Cen-ter, and a spokesperson for the Skin Cancer Foundation.

new hope for advanced cancersOnce the melanoma has spread beyond the skin tissue and af-fected any of the local or region-al lymph nodes, it is considered to be at Stage III. While cancers at this stage will require more ag-gressive treatment—including surgery and other adjuvant ther-apy such as chemotherapy or ra-diation—survival rates are im-proving. And even for cancers that have reached Stage IV, the most advanced disease in which it has spread to lymph nodes dis-tant from the primary tumor or to internal organs, experimental, high-tech treatments are provid-ing more options for successful outcomes.

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■■ What are the benefits of clinical trials as they relate to skin cancer?

Skin cancer is the most com-mon form of cancer in the United States and is increasing at an alar-ming frequency. However, most skin cancers can be prevented by avoiding exposure to ultraviolet radiation, and many can be cured by early detection and surgical re-moval. While all skin cancers can be fatal if they spread beyond the skin, melanoma is the most ag-gressive and, at present, the only drug that can improve survival for advanced disease is high-dose Interleukin-2. There are no drugs available for the treatment of ad-vanced basal cell or squamous cell skin cancers. Thus, the identifica-tion of new treatment options for all forms of advanced skin can-cer is a major priority. We now ha-ve a better understanding of how skin cancers develop at the mo-lecular level, which has led to a significant increase in the num-ber of new drugs that can be used against these molecular targets. However, new drugs must be ri-gorously tested for safety and ef-fectiveness through clinical tri-als, and willing participants are critical to that process. Although participation does not guarantee personal benefit, access to new drugs could positively impact the patient’s disease and definitely provide an opportunity to advan-ce the discovery of new skin can-cer treatments.

■■ How important is early detec-tion to effective treatment of skin cancer?

Early detection is very im-portant in treating both basal and squamous cell carcinomas, and can mean the difference between life and death when treating me-lanoma. Basal cell carcinoma is the most common cancer in the world, and more than 75 percent form on the face and neck due to sun exposure. Though they are ra-rely lethal, people do tend to get multiple lesions. Similarly, squa-mous cell cancers tend to affect the head and neck and metasta-size only rarely. Both of these can-cers are easily treatable with sur-gery, but it is ideal to remove them in the earliest stages when they are small and require a less visible incision. Though it is far less com-mon than basal and squamous cell cancers, melanoma is one of the most dangerous and aggres-sive of all cancers. Early detec-tion of melanoma can literally sa-ve a patient’s life because it starts off superficially on the outside of the skin before it can metastasi-ze. I cannot stress enough the im-portance of knowing your own skin, including the back, scalp and back of the neck because melano-mas tend to be darkly pigmented and relatively easy to spot. Almost 90 percent of melanomas are found early and effectively trea-ted by surgical removal.

■■ What is immunotherapy, and how is it being used to treat skin cancer?

Cancer immunotherapy at-tempts to train the body’s immune system to recognize and attack cancer, just as vaccines stimulate an immune system response to fight childhood and infectious di-seases.

Immunotherapy is fundamen-tally different from all other cancer treatments because it treats the patient, and the patient treats the cancer. Rather than directly at-tacking the tumor, immunothera-py is a longer-term approach that allows the body to fight cancer on its own.

We know the immune system can be extremely potent and has a great memory, which explains why vaccinations given in infancy are effective for many years. Simi-larly, if we can bring the immune system on board when treating cancer we may be able to elimi-nate recurrence—one of the great challenges in cancer treatment.

Melanoma is an ideal target for immunotherapy because the im-mune system could spontaneously recognize it, though it cannot con-trol it completely. Currently, there are two approved immunotherapy drugs that target melanoma—In-terferon-alpha and Interleukin-2. The benefits are long lasting for those who respond. Ipilimumab is another new immunotherapy drug that we hope will be FDA-approved in the near future.

■■ What therapies are there for patients with melanoma?

Clinical trials of new therapies for melanoma patients offer hope that we may find treatments that are more effective and less tox-ic than those currently approved by the Food and Drug Adminis-tration. Many of these new treat-ments are immunotherapies, or agents that boost the immune re-sponses, and biologics, which add new modalities to the standard therapies of surgery, chemothera-py and radiation therapy.

Currently, there are investiga-tional therapies for patients in all stages of melanoma that may be used early in the course of disease to prevent spread, or after meta-stasis in an effort to shrink or er-adicate the tumor. Many thera-pies work to enhance the body’s immune response while some inhibit the growth of blood ves-sels that feed tumors. Still oth-ers target specific defects in the patient’s own tumor, signaling the dawn of a new era of persona-lized medicine.

“A melanoma diagnosis can be scary for anyone but there are many treatment options now. Pa-tients with melanoma should consider visiting a specialized Melanoma Center whose speci-alists are aware of the new tre-atment options,” says Dr. Spitler. “This a exciting time because the-re are so many promising new th-erapies in clinical trials.”

■■ What should people consider when developing a proactive ap-proach to skin health?

Certain skin types are more prone to developing skin cancer and, in general, people with fair skin, freckles, blue eyes, strawber-ry-blonde hair or a family history should be diligent about exami-ning their skin. In addition, pe-ople who have more than 100 mo-les or have a history of excessive sunburns are at increased risk of developing skin cancer and mela-noma.

Everyone should ask his or her dermatologist how to conduct an effective skin exam, a health be-havior that can easily be done af-ter a shower. Oftentimes, a spouse or significant other can be helpful, but a hand-held mirror is also ef-fective. When conducting a skin exam, I encourage people to pay particular attention to new deve-lopments on the skin and careful-ly inspect existing moles. A trick to remembering what to look for is a tool called the “A-B-C-D-E’s of Melanoma”:Asymmetry—Moles should have

nice, crisp, symmetrical sides.Borders—We want nice rounded

edges, not bumpy or cauliflo-wer-like.

Color—Consistency is important.Diameter—Anything larger than

an eraser head should be exa-mined by a doctor.

Evolution—Even if you are a born with a mole, see a physician if it seems to change.

howard kaufman, mdAssociate dean and directorRush Cancer program Rush university medical Center

james goydos, mdAssociate professor of surgeryCancer Institute of new Jerseymollie’s Fund, Advisory board

lynn e. spitler, mddirectornorthern California melanoma Centerst. mary’s medical Center

jedd d. wolchok, md, phddirector of Immunotherapy andClinical trials; Associate Attending in melanoma and sarcoma, memorialsloan-Kettering Cancer Centermollie’s Fund, Advisory board

anna pavlick, doAssociate professordepartment of medicine and dermatology, langone medical Center new york university mollie’s Fund, Advisory board

PARSOL® 1789 THE BEST WAY TO REACH THE ULTIMATE UV-A PROTECTIONDSM NUTRITIONAL PRODUCTS45 Waterview Boulevard, Parsippany, NJ 07054; United States of AmericaPhone: +1 800 526-0189 Email: [email protected]

How can that be? Until recently, it was believed that a sunscreen with a high sun protection factor (SPF) was all you needed to protect your skin from harmful UV rays. The truth is that SPF only measures protection from one type of UV ray – Ultraviolet B (UVB). These are the rays that cause sunburn. Unfortunately, SPF protection does not mean skin cancer prevention. Research has found that skin damage is cumula-tive and is from both UVA and UVB rays. UVB rays will cause sunburn and changes to skin pigmenta-tion, but UVA rays affect the skins deeper layers and are linked to premature aging and melanoma, the deadliest form of skin cancer. “We now know that longer UVA rays cause damage to the cellular DNA as well as immunosuppression, causing cancer to flourish” claims Dr. Ashinoff.

How can you get the best protection?To get the best protection year round, dermatolo-gists recommend using sunscreens that provide both UVA and UVB protection. “It is important to make sure you apply a broad-spectrum sunscreen containing UVA and UVB protection because UVA rays weaken the body’s defense mechanisms from cancer and other diseases” states Dr. Ashinoff.

How can you make sure your sunscreen offers UVA protection? Look for products that contain Avobenzone, also known as PARSOL® 1789. This was one of the first UVA-blocking ingredients approved by the FDA in the United States. PARSOL® 1789 is a unique UVA filter which provides protection across the entire UVA spectrum. It intercepts and absorbs most dangerous UVA rays before they penetrate the skin and cause long-term damage. Dr. Ashinoff also recommends that “reapplication after swimming and perspiring is necessary to make sure that you are adequately covered and to apply a good coat of sunscreen (about one shot-glass full) about 30 minutes before exposure to the sun to provide time for binding to the skin”.

Too many labels too little time?The sunscreens of today have surpassed the sim-plicity and limited capacity of their earlier counter-parts. They offer the sophistication of higher SPF, water resistance, and broad-spectrum protection (both UVA and UVB). With all these new benefits, it is easy to overlook the basics of sun protection. To ensure you are getting the best protection you can from your sunscreen, it is important to read the label and look for PARSOL® 1789 or Avobenzone on the front of the package or in the active ingredient list. This will let you know that your sunscreen offers this critical UVA protection. With this broad-spectrum protection you can rest assured that you are cov-ered from UVA to UVB for even brighter days ahead.

How to choose a sunscreen:– Read the label and look for PARSOL® 1789 or

Avobenzone. This will provide you with the best broad-spectrum UVA protection.

– Look for products that have an SPF of 15 or higher.– Check the expiration date. – Find a product application that is suitable for you

(spray, lotion, gel, etc.).

For questions or comments please contact: DSM NUTRITIONAL PRODUCTS, INC.Kathy MaurerPersonal Care Sr. Marketing Manager Phone: +1 973 257-8255Email: [email protected]

Did you know that two sunscreens with the same SPF may not be protecting your skin in the same way? It is a well known fact that the purpose of sun pro-tection is to shield the skin from the harmful effects of UV radiation. However, it is a little known fact that these harmful effects extend beyond the pain of simple sunburn. “Exposure to UV rays is a rec-ognized risk factor for skin cancer” says Dr. Robin Ashinoff, a New Jersey dermatologist from Hacken-sack University Medical Center. Despite what you may think, even if your sunscreen is preventing you from getting burned, it may not be offering you full protection. “UVB prevents sunburn, but unless there is adequate UVA protection in your sunscreen, there is immunosuppressant oxidation occurring in your skin” says Dr. Ashinoff.

MAKING SURE YOUR SUNSCREEN HAS YOU COVERED FROM A TO B

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