Naturally occurring substance proves effective against deadly skin cancer in laboratory tests

Another substance to add to the list:


Naturally occurring substance proves effective against deadly skin cancer in laboratory tests April 10, 2013 in Cancer For the first time, scientists have demonstrated the mechanism of action of gossypin, a naturally-occurring substance found in fruits and vegetables, as a treatment for melanoma, which causes the majority of deaths from skin cancer  “We identified gossypin as a novel agent with dual inhibitory activity towards two common mutations that are the ideal targets for melanoma treatment,” said Texas Biomed’s Hareesh Nair, Ph.D. At the moment, there is no single therapeutic agent or combination regimen available to treat all melanomas, of which about 76,000 new cases are diagnosed annually, according to the American Cancer Society. “Our results indicate that gossypin may have great therapeutic potential as a dual inhibitor of mutations called BRAFV600E kinase and CDK4, which occur in the vast majority of melanoma patients. They open a new avenue for the generation of a novel class of compounds for the treatment of melanoma,” Nair added. His report, appearing in the March 29, 2013 issue of the journal Molecular Cancer Therapeutics, was funded by the Texas Biomedical Forum and the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation. Nair and his colleagues found that gossypin inhibited human melanoma cell proliferation, in vitro, in melanoma cell lines that harbor the two mutations. Gossypin stunted activities of the mutated genes, possibly through direct binding with them. It also inhibited the growth of various human melanoma cells. In addition, gossypin treatment for 10 days of human melanoma cell tumors with the mutations transplanted into mice reduced tumor volume and increased survival rate. Further studies are planned by Nair’s team to understand how the body absorbs gossypin and how it is metabolized. This idea has been discussed with the Cancer Therapy & Research Center at the UT Health Science Center San Antonio’s Deva Mahalingam, M.D, Ph.D., who is interested in testing gossypin in melanoma patients. Journal reference: Molecular Cancer Therapeutic

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Many skin cancer survivors ignore sun safety advice

A lot of news out today about this
Wear your sunscreen, seek the shade, wear protective clothing and never, ever go to a tanning salon. Despite decades of repetition, many of us fail to follow that skin-saving advice — and a new study shows that’s true even for people who have had the most serious form of skin cancer.

More than a quarter of people who have had melanoma say they never use sunscreen, according to the study presented at a medical meeting Monday. Even greater numbers eschew hats and long sleeves, and 2% admit they have used a tanning bed in the last year, say researchers from Yale University, who presented the data at the annual meeting of the American Association for Cancer Research in Washington, D.C.

Cancer survivors are a bit more careful than the rest of us: 32% always wear sunscreen, while just 17% of other adults do. Overall, they also are more likely to wear hats and long sleeves and stay in the shade. But when compared with others with the same age, race and insurance coverage, the differences are only significant when it comes to sunscreen use, says researcher Anees Chagpar. In other words, a 40-year-old white person with insurance coverage who has been through cancer treatment is just as likely to use a tanning bed or go outside without a wide-brimmed hat as one who has not.

Chagpar, a cancer surgeon, says she finds the data on indoor tanning especially “shocking and concerning.” She says the findings raise questions about whether some people might be “addicted” to tanning.
The study of nearly 27,000 people included 171 who said they had a history of melanoma, which, like other skin cancers, is linked to sun exposure and indoor tanning. It is most common in people with fair skin and a history of sunburns, and it can run in families. It will kill about 9,000 people in the USA this year, according to the non-profit Skin Cancer Foundation.

Survivors are nine times more likely than other people to have melanoma in the future, so experts advise them to take their skin protection seriously.

Several previous studies have suggested such vigilance is hard to maintain, though some studies do find better compliance than the latest survey does, says Mary Tripp, a behavior researcher at the University of Texas MD Anderson Cancer Center in Houston. A possible weakness of the new survey, which has not yet been published, is that it relies on self-reported medical histories, which are sometimes inaccurate, she says.
But she says she has interviewed melanoma survivors who have let down their guard.

“When someone is first diagnosed, they are practicing sun protection, but as the years go by, maybe they tend to fall back on their old habits,” she says. “A lot of melanoma survivors have told me that it is very important for them to maintain a normal outdoor lifestyle.”

Dermatologists don’t want melanoma survivors or the rest of us to stay indoors all the time, says Ali Hendi a dermatologist in Chevy Chase, Md., and a spokesperson for the Skin Cancer Foundation.
Anyone who wants to garden, golf or walk outside should do it, but “be smart about it,” he says, by staying out of the midday sun and using shade, sunscreen and protective clothing.

“You can’t change your genetic makeup, you can’t change the kind of skin you have and you can’t change previous sunburns,” but you can lower your risk, even if you have already had skin cancer, he says.
Still, those who don’t follow that advice have plenty of company, Hendi says: “There are smokers who still continue to smoke after being diagnosed with lung cancer. There are a lot of people in our society who do things they know are not good for them.”

Addiction and denial can play roles in such behaviors, but a lack of complete information may, too, Chagpar says. She says doctors and health educators may need to do a better job of telling people how and why to protect themselves.

Summary of April JAAD articles

Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border

Thomas L. Hocker, MD,a Ali Alikhan, MD,a Nneka I. Comfere, MD,a,b and Margot S. Peters, MDa,b

Rochester, Minnesota

See related letters on pages 682 and 683

Background: Patients with multiple clinically dysplastic nevi are at increased risk for development of melanoma. However, the risk of melanoma arising in a histologically dysplastic nevus (HDN) is unknown.

Objective: We sought to determine the rate of melanoma development in patients with HDNs that approached a microscopic border but were not re-excised.

Methods: We performed a retrospective study of patients evaluated in our dermatology department from January 1, 1980, to December 31, 1989, who had a HDN that extended to within 0.2 mm of a microscopic punch, shave, or excision border and was not re-excised.

Results: The average follow-up in our cohort of 115 patients was 17.4 years (range: 0.0-29.9): 82 patients (71.3%) were followed up for longer than 10 years, 78 (67.8%) longer than 15 years, and 73 (63.4%) had more than 20 years of follow-up; 66 of 115 nevi were mildly dysplastic, 42 moderately dysplastic, and 7 had severe dysplasia. No patient developed metastatic melanoma or melanoma at the site of removal of a HDN.

Limitations: This was a retrospective study performed at 1 large academic medical center.

Conclusion: During a long-term follow-up period, no patient developed melanoma at the site of an incompletely or narrowly removed HDN, providing evidence that routine re-excision of mildly or moderately dysplastic nevi may not be necessary. ( J Am Acad Dermatol 2013;68:545-51.)



Negative pigment network: An additional dermoscopic feature for the diagnosis of melanoma

Maria A. Pizzichetta, MD,a Renato Talamini, ScD,a Ash A. Marghoob, MD,b H. Peter Soyer, MD,c Giuseppe Argenziano, MD,d Riccardo Bono, MD,e M. Teresa Corradin, MD,f Vincenzo De Giorgi, MD,g Marian A. Gonzalez, MD,h Isabel Kolm, MD,I Andrew W. Kopf, MD,j Joseph Malvehy, MD,k Niccolo Nami, MD,  Margaret Oliviero, MD,I Giovanni Pellacani, MD,m Susana Puig, MD,k Harold Rabinovitz, MD,I Pietro Rubegni, MD,l Stefania Seidenari, MD,m Ignazio Stanganelli, MD,n Andrea Veronesi, MD,a Iris Zalaudek, MD,o Pierfrancesco Zampieri, MD,h and Scott W. Menzies, MB, BS, PhDp Aviano, Reggio Emilia, Rome, Pordenone, Florence, Merano, Siena, Modena, and Meldola, Italy; New  York, New York; Miami, Florida; Barcelona, Spain; Graz, Austria; and Brisbane and Sydney, Australia

Background: The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure.

Objectives: We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions.

Methods: Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN.

Results: The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%),melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas.

Limitations: Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions.

Conclusions: The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric  pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.

( J Am Acad Dermatol 2013;68:552-9.)



Nodular melanoma: A distinct clinical entity and the largest contributor to melanoma deaths in Victoria, Australia

Victoria Mar, MBBS, FACD,a,b,c Hugh Roberts, MBBS, FACD,a Rory Wolfe, BSc, PhD,a,b Dallas R. English, BSc, PhD,d,e and John W. Kelly, MBBS, FACD, MDa Melbourne, Australia

Background: There is a growing body of evidence that nodular melanoma (NM), because of its association with increased growth rate and thickness at diagnosis, accounts for a substantial proportion of melanoma deaths.

Objective: We sought to assess the contribution of NM to melanoma deaths in comparison with other tumor subtypes.

Methods: Four cohorts were established comprising 5775 cases of invasive primary cutaneous melanoma reported to the Victorian Cancer Registry during 1989, 1994, 1999, and 2004. Original pathology reports were reviewed. Age-standardized melanoma incidence rates were compared from 1989 to 2004 with annual percentage change using Poisson regression.

Results: The incidence of thick tumors ([4 mm) increased by 3.8% (95% confidence interval 1.4 to 6.2) and 2.5% (95% confidence interval 0.5 to 5.5) per year for male and female patients, respectively. The median thickness of NM at diagnosis was 2.6 mm compared with 0.6 mm for superficial spreading melanoma. A third of patients who died from melanoma during the follow-up period had thick tumors ([4 mm), most of which were nodular subtype (61%). NM accounted for 14% of invasive melanomas, but was responsible for 43% of melanoma deaths in a total of 57,461 person-years of follow-up. By comparison, superficial spreading melanoma contributed 56% of invasive melanoma but only 30% of deaths.

Limitations: Pathology review was limited to reports only. Mortality information relied mostly on death certificate information.

Conclusion: The incidence of thick melanomas continues to increase. Nodular melanoma is clinically distinct and the predominant contributor to melanoma-related deaths, representing a public health challenge in reducing skin cancer mortality. ( J Am Acad Dermatol 2013;68:568-75.)

Key words: histologic type; melanoma; melanoma deaths; melanoma incidence; melanoma survival; nodular melanoma; tumor subtype.



Pigmented solar (actinic) keratosis: An underrecognized collision lesion

Hye Jin Chung, MD,a Kelly L. McGuigan, MD,b Katie L. Osley, MD,a Kate Zendell, MD,a and Jason B. Lee, MDa Philadelphia, Pennsylvania, and Annapolis, Maryland

Background: The lack of well-established diagnostic criteria for pigmented solar (actinic) keratosis (PSK) along with its poorly understood etiopathogenesis has contributed to underrecognition.

Objective: The clinical, dermatoscopic, and histopathologic features of PSK and the cause of the pigmentation are elucidated.

Methods: In all, 167 histologic specimens, 22 clinical images, and 17 dermatoscopic images of PSK were reviewed. In 38 cases, Melan-A stained sections were available for analysis.

Results: The majority of the lesions were located on the head and neck (84%). A separate pigmented lesion was adjacent to or admixed within PSK in 138 (83%) of the cases indicating that PSK represents a collision between a nonpigmented solar keratosis and a pigmented lesion. Solar lentigo (72%) was the most commonly associated pigmented lesion followed by seborrheic keratosis and melanoma. PSK was suspected clinically in 17% of the cases. There were no significant differences in the quality and quantity of the melanocytes between pigmented and nonpigmented solar keratosis.

Limitations: This was a single-center retrospective study. The sample sizes were small for the clinical and dermatoscopic images and Melan-A stains.

Conclusion: In the majority of the cases, a collision between a nonpigmented solar keratosis and a separate coexistent pigmented lesion, primarily a solar lentigo, accounts for the pigmentation in PSK rather than from any fundamental changes in the quantity or quality of the melanocytes. The collision phenomenon accounts for the spectrum of the clinical and dermatoscopic features observed in PSK and its underrecognition. ( J Am Acad Dermatol 2013;68:647-53.)

Key words: collision tumor; Melan-A; melanoma; pig


More evidence about aspirin and melanoma risk reduction

Hi all


There has been a huge amount of news about this in the last week, eg:


Notice in the first link they say, not enough evidence to recommend yet but in the second link the dermatologist would recommend if there were no contra-indications





Taking Omega-3 Supplements May Help Prevent Skin Cancer

This came out yesterday

Results of the study, funded by the Association for International Cancer Research, found that taking a regular dose of fish oils boosted skin immunity to sunlight. Specifically, it also reduced sunlight-induced suppression of the immune system, known as immunosuppression, which affects the body’s ability to fight skin cancer and infection. The findings have been published in The American Journal of Clinical Nutrition this month.

Professor Rhodes, who is based in the Photobiology Unit at the University’s School of Medicine and Salford Royal NHS Foundation Trust, said it was the first time the research had been carried out on humans. “There has been research in this area carried out on mice in the past but this is the first time that there has been a clinical trial directly in people,” she said. “It has taken a number of years to get to this stage and the findings are very exciting.

“This study adds to the evidence that omega-3 is a potential nutrient to protect against skin cancer. Although the changes we found when someone took the oil were small, they suggest that a continuous low level of chemoprevention from taking omega-3 could reduce the risk of skin cancer over an individual’s lifetime.”

Patients who volunteered for the trial took a 4g dose of omega-3, which is about one and a half portions of oily fish, daily and were then exposed to the equivalent of either 8, 15 or 30 minutes of summer midday sun in Manchester using a special light machine. Other patients took a placebo, before being exposed to the light machine. Immunosuppression was 50% lower in people who took the supplement and were exposed to 8 and 15 minutes of sun compared with people who did not take the supplement. The study showed little influence on those in the 30 minute group.

The findings are important in the battle against skin cancer because previous research has shown that sunscreens are often applied inadequately and only worn during holiday periods. However, Professor Rhodes stressed that the omega-3 was not a substitute for sunscreen and physical protection, and that omega-3 should be regarded as an additional small measure to help protect skin from sun damage. The fish oil has already been shown to have many beneficial health effects such as helping with cardiovascular disease, meaning taking the supplement could lead to a range of potential health benefits

Hyfrecators and Interference with Implantable Cardiac Devices

I have always wondered if this was an urban myth. It never stopped me using the hyfrecator before!



Investigation of Hyfrecators and Their In Vitro Interference with Implantable Cardiac Devices


BACKGROUND Guidelines exist for minimizing potential electromagnetic interference (EMI) with electrosurgical equipment in patients with cardiac rhythm management (CRM) devices. These guidelines encompass all electrosurgical devices but are not specific for hyfrecators.

OBJECTIVE To investigate the potential interference of CRM devices by hyfrecators.

MATERIALS AND METHODS Using a collagen-based saline gel, three implantable pulse generators (pacemakers) and three implantable cardioverter defibrillators were tested to measure the EMI from two commonly used hyfrecators. The six devices were tested using the hyfrecator under normal use settings and on maximum power.

RESULTS Hyfrecators did not interfere with defibrillators and affected pacemakers only when used in close proximity to the device. For the pacemakers, atrial inhibition was observed at a distance of 3 cm on maximum hyfrecator settings and 1 cm at normal use settings. Ventricular inhibition occurred in very close proximity to the device (<1 cm) or in direct contact.

CONCLUSION Hyfrecators are safe to use in patients with defibrillators and can be used in pacemaker patients within 2 inches of the device perimeter.

Vitamin D Level and Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma Risk

This is a great review of a complex topic. Let me know if you want a copy of the article.



Various associations between serum vitamin D levels and skin cancer have been reported. In this issue, van der Pols et al. observed that baseline 25-hydroxyvitamin D (25OHD) levels above 75 nmol/L were associated with an increased incidence of basal cell carcinoma and melanoma, and a nonstatistically significant decreased incidence of squamous cell carcinoma. Complex factors including sun exposure, skin phototype, and anticarcinogenic and procarcinogenic effects of vitamin D are potential causes of the observed associations.


Journal of Investigative Dermatology (2013) 133, 589–592. doi:10.1038/jid.2012.427

Transection and melanoma survival

I suppose this study supports what we already know




The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival

Mohsin Mir, MD, C. Stanley Chan, MD, Farhan Khan, MD, MBA, Bhuvaneswari Krishnan, MD,

Ida Orengo, MD, and Theodore Rosen, MD

Houston, Texas


Background: Depth of melanoma invasion is critical because it dictates patient treatment and prognosis.

Recent reports indicate melanoma transection with initial biopsy does not impact patient survival; however,

tumor transection can lead to misdiagnosis and inaccurate staging.


Objective: This study assessed the rate of melanoma transection with various biopsy techniques and the

impact of tumor transection on patient survival.


Methods: We conducted a retrospective review of all melanoma cases at our institution between 2000 and

2008. Of the 490 melanoma cases identified, 479 met inclusion criteria for the study. The transection rates of biopsy techniques were determined. Cases of transected tumors were matched with nontransected cases in a retrospective case-control fashion to evaluate survival.


Results: The rate of melanoma transection was 1.5% for excisional biopsies, 4.1% for punch biopsies, and

9.0% for saucerization biopsies. The means of disease-free survival for the control and transected groups

were 911 days and 832.7 days, respectively (P value .67). Overall survival for the control group was 1073.7

days versus 1012.4 days for the transected group (P value .72).


Limitations: The study used a select population. The sample size of transected biopsies was limited, in

turn limiting the power of the study. Residents performed the majority of biopsies.


Conclusion: Punch and saucerization biopsies were more likely to transect tumors than excisional

biopsies. The transection of melanoma did not affect overall disease-free survival or mortality in the

population studied. ( J Am Acad Dermatol 2013;68:452-8.)

Desmoplastic Melanoma Review

This article is useful




Clinical and Dermoscopic Characteristics of Desmoplastic Melanomas

Objective: To describe and analyze the clinical and dermoscopic characteristics of desmoplastic melanoma (DM) as a function of pathologic subtype and phenotypic traits.

Design: Retrospective case series.

Setting: Eight high-risk dermatology clinics.

Patients: Patients with DM confirmed by histopathologic analysis whose records included a high-quality dermoscopic image.

Main Outcome Measures: Clinical, dermoscopic, and histopathologic features of DM.

Results: A total of 37DMcases were identified. The majority of patients had fair skin, few nevi, and no history

of melanoma. Lentigo maligna was the most frequent subtype of melanoma associated with DM. The most frequent clinical presentation of DM was a palpable and/or indurated lesion located on sun-exposed skin. Fortythree percent of cases were classified as pure DM, and 57% as mixed DM. Pure DM lesions were thicker than mixed DM lesions (4.10 vs 2.83 mm) (P=.22) and were less likely to have an associated epidermal non-DM component (63% vs 100%) (P=.004). Dermoscopically, DMs had at least 1 melanoma-specific structure, the most frequent being atypical vascular structures. Peppering was more frequently seen in pure DM (44% in pure DM vs 24% in mixed DM) (P=.29). In contrast, crystalline structures, polymorphous vessels, and vascular blush were more commonly seen in mixed DM.

Conclusions: Though DM can be difficult to diagnose based on clinical morphologic characteristics alone, dermoscopy has proved to be a useful aid during the evaluation of clinically equivocal lesions or those lesions with a benign appearance. The most common dermoscopic clues observed in DMs included atypical vascular structures, peppering, and occasionally other melanoma specific structures.

JAMA Dermatol.

Published online January 16, 2013.


A Spitzoid lesion

Great to get comments on this case



A Spitzoid lesion