Dr. Susan Mayne

For many years, dermatologists have noted an increasing number of young women presenting with the most common form of skin cancer called basal cell cancer. Now, a study we conducted at Yale, led by colleagues Dr. Susan Mayne and Dr. Leah Ferrucci, sheds new light on this unexpected and unfortunate trend. The good news is that those who use tanning parlors now have good reason to stop doing so. For more information about this extensive study click here or click here. Not surprisingly representatives of the tanning parlor industry will make spurious claims about the safety of tanning parlor use. The scientific evidence suggests otherwise. The publication of this study in the Journal of the American Academy of Dermatology is very timely. Recently, California banned tanning parlor use in minors. In Connecticut there is a revived effort ( for the fourth time) to pass legislation requiring parental consent to allow minors to use tanning parlors. It is noteworthy that both cigarettes and ultraviolet radiation such as that emitted in tanning parlors, are carcinogenic. One wonders why the same regulations do not apply to tanning parlors as apply to access to cigarettes.

Dr. Leah Ferrucci

 

In a regrettable demonstration of confused priorities state senator Michael McLachlan squelched a law that would have protected thousands of teenagers, mainly girls from the dangers of artificial tanning. Such tanning has been scientifically proven to cause skin cancer and melanoma. The bizarre amendment that McLachlan used to scuttle the tanning law would have required the same parental consent for abortions by minors. To be fair there are legitimate positions on either side of the abortion argument but it should not have been conflated with attempts at protecting children from potentially deadly activity. Tanning parlors must be regulated at least in the same fashion as we control cigarette access to minors. It seems McLachlan probably is not familiar with the evidence linking ultraviolet radiation to cancer. I routinely see young women now with skin cancer, most of whom have used artificial tanning parlors in their teenage years.The health of our children, born or unborn, is not a zero sum game. Protecting children from one harm does not mean we believe in harming them in another fashion. But if you think this way, as McLachlan apprently does, we will lose many easy opportunities to protect the health of the next generation.

Thanks to Nancy Alderman’s activism, the tanning bill made it right up to the end. Her relentless efforts at passing intelligent tanning parlor regulations will prevail.Read the editorial in the Danbury News Times. Nancy has worked very hard to educate newspaper editors and opinion leaders about the need for tanning parlor regulation, and in this case the harmful, needlessly provocative actions of McLachlan.

It was a busy few days after the FDA announced its new sunscreen labeling guidelines. On balance, the public will benefit but complete clarity remains elusive. Bottom line: use a sunscreen with an SPF of 30 that also provides broad spectrum (ingredients to look for: avobenzone or zinc oxide) apply every couple of hours while active outdoors (claims of sweat-proof and waterproof will no longer be accepted by the FDA); and make sure that you avoid the sun during peak hours of 10 am to 4 pm. Don’tforget hats and other sun protective clothing as you’ll read in the NPR interview.

 Here’s a brief extract of my comments from All Things Considered with Nancy Shute:

The FDA says there’s no such thing as a waterproof sunscreen. They all wash off in the pool, or with sweat. Starting next summer, the best a label will be able to claim is that a sunscreen is water resistant.

Leffell adds:

“A white T-shirt gives you a sun protection factor of 6, which frankly is not very helpful at all,” he says. “But there are so many products out there: sun-protective clothing products that are rated for their sun protection and don’t look like prison uniforms anymore. They actually look like real clothing.”

And protective clothing that looks like real clothes is a good thing, because skin cancer rates in young people are on the rise. Leffell is seeing cases of young women in their 20s developing skin cancer, “which used to be unheard of,” he says.

Listen to the segment itself

Also, other points are made in the Hartford Courant

My Quick Take on the New Regs

As I mentioned yesterday, the FDA guidelines for sunscreen labeling have been published. The final guidelines clearly reflect the input that has been received through the public comment period. Here are the key points in the new rules in the FDA’s own words with my comments in italics:

  • Broad Spectrum designation.Sunscreens that pass FDA’s broad spectrum test procedure, which measures a product’s UVA protection relative to its UVB protection, may be labeled as “Broad Spectrum SPF [value]” on the front label. For Broad Spectrum sunscreens, SPF values also indicate the amount or magnitude of overall protection. Broad Spectrum SPF products with SPF values higher than 15 provide greater protection and may claim additional uses, as described in the next bullet. This is a reasonable guideline that seeks to provide the consumer with some clarity around the issue of “broad spectrum” coverage. I typically recommend sunscreen with SPF minimum of 15 to 30 so this guideline is reinforcing.
  • Use claims. Only Broad Spectrum sunscreens with an SPF value of 15 or higher can claim to reduce the risk of skin cancer and early skin aging if used as directed with other sun protection measures. Non-Broad Spectrum sunscreens and Broad Spectrum sunscreens with an SPF value between 2 and 14 can only claim to help prevent sunburn. Sunscreen less than SPF 15 is unhelpful in terms of skin cancer protection so I am glad this has been defined for the public. Also, critical to note that “other sun protection measures” must be followed to optimize skin cancer risk reduction.
  • “Waterproof, “sweatproof” or “sunblock” claims.Manufacturers cannot label sunscreens as “waterproof” or “sweatproof,” or identify their products as “sunblocks,” because these claims overstate their effectiveness. Sunscreens also cannot claim to provide sun protection for more than 2 hours without reapplication or to provide protection immediately after application (for example– “instant protection”) without submitting data to support these claims and obtaining FDA approval. This rule is consistent with what I have been telling patients all along: regardless of what the label says, reapply every couple of hours while outdoors. Its a hassle, but very doable when you consider the alternative.
  • Water resistance claims. Water resistance claims on the front label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while swimming or sweating, based on standard testing. Sunscreens that are not water resistant must include a direction instructing consumers to use a water resistant sunscreen if swimming or sweating. Reasonable.
  • Drug Facts. All sunscreens must include standard “Drug Facts” information on the back and/or side of the container. Probably the most helpful addition: we all read those boxes with detailed information. While sunscreens are over-the-counter products, they are obviously regulated. They have significant beneficial effects and this new requirement will help consumers better understand what ingredients do. The more useful information, the better!

After years of discussion the FDA will announce new sunscreen labeling guidelines today. The general public, dermatologists and sunscreen manufacturers have been eagerly awaiting the final “monograph” which is intended to clarify sunscreen labeling and make the information for consumers more practical and understandable. The FDA announcement should quell some of the inaccurate claims about sunscreen safety and usefulness while at the same time providing guidelines for ultraviolet A protection standards in sunscreens which so far have applied to ultraviolet B radiation (SPF rating system).

Sun Hygiene Activities

Consistent sun hygiene includes regular use of sunscreen or sunblock.

In a recent interview with Marketwatch.com I coined the term “sun hygiene” to specifically refer to those activities that are proven to help maintain your skin in healthy condition while outdoors. Dermatologists talk frequently about the ways to protect your skin from the damaging effects of ultraviolet radiation, and dentists talk frequently about the importance of good dental hygiene to maintain your teeth and gums in a healthy state. In essence, care of your skin needs to follow the same daily routine that you pursue for dental health. The care, when it comes to your skin, goes beyond just the use of sunscreen, which is critical, but involves a whole range of simple steps that will help your skin stay healthy and attractive throughout your life.

Here are five key steps to effective sun hygiene: Continue Reading »

Melanoma Alphabet

The majority of cases of melanoma are treatable when diagnosed early. The seriousness of a particular melanoma relates to its thickness, so if the melanoma can be diagnosed when it is thin and less risky, simple surgical removal often yields an extremely high cure rate.

Atypical appearing mole

More than two decades ago, a general guideline was developed to help people recognize skin lesions that could be melanoma. The so-called “ABCD” guideline was a simple way of identifying key factors of moles or other lesions that required prompt attention to make sure that melanoma was not developing or already present. Ultimately, melanoma can only be diagnosed by skin biopsy, but whether through self skin exam, an annual skin exam by your physician, or if you have a lesion that is concerning, it is important to know whether the growth truly requires additional attention.

Hopefully, the ABCD paradigm, which some expand to include the E for “evolving”, and I expand to include the letter S, for suspicious, is well known. Here is a brief reminder but it should be remembered that this just represents an aid to recognition and should not replace any specific concerns that you have about particular skin lesions.

A–asymmetry. If you look at the lesion and fold it in half in your mind’s eye the two sides do not match. Normal moles typically grow in a somewhat circular and therefore symmetric fashion. Abnormal moles and melanoma, because of factors related to their biology of growth, may develop an asymmetric appearance. Continue Reading »

Dermatologists recommend an annual total body skin examination as a means to identify skin cancer and melanoma at its earliest most treatble stage. While melanoma and skin cancer can be dangerous, the good news is that careful monitoring of your skin allows you to become better aware of the moles and skin growths so that abnormal lesions can be identified and changes in moles will be more apparent. While the majority of skin cancers are probably identified by the patient or partner (female spouses and partners are best at this in my opinion), there are often lesions that are not of concern to the patient but identified by the doctor as suspicious and therefore in need of biopsy or close monitoring.

The Total Body Skin Exam

When we say “TOTAL” we mean “TOTAL”. The proper exam is performed in a well lighted room with the aid of a magnifier if necessary. The doctor or other specially trained care provider should be systematic and study the skin from the scalp to the feet, including often ignored areas like the palms, soles and in between the toes. One patient told me his dermatologist did not want to examine his scalp because “he had too much hair”. Most balding men would view that as a good problem to have but its not an excuse to perform an inadequate exam. Scalp should be examined carefully ( in many people the scalp has received much sun over the years). Hair should be parted with fingers, a comb or even a hair dryer set on cool. Many people are surprised by how fast some doctors perform a full skin exam. In fact, skin examination is all about pattern recognition and at a first pass very concerning lesions do jump out. Closer exam of these lesions is then necessary. The length of the exam is less important than its completeness and your sense that it has been thorough. If you are wearing naill polish, you must return to have the doctor examine your nail area or make sure you do so yourself when the polish is removed. There has been a spate of new products and machines  that claim to systematically scan for moles and skin cancer. Most of these are just sophisticated digital imaging methods that serve as an aid to identify lesions of concern but are not in themselves diagnostic tools. For now the best computer for melanoma identification resides between the two ears of the dermatologist.

In addition to the annual full skin exam, people at high risk for skin cancer:

1. people with fair hair, fair skin or blue, grey or green eyes

2. people with a family history of skin cancer or melanoma

3. people who have had blistering sunburns in childhood

should all be seen a second time each year for examination of the high risk sun exposed areas. After that follow the recommendation of yoru dermatologist for a follow-up plan unique to your situation

Moles of concern include those that are greater than 6-7 mm (the size of a pencil erase); asymmetric (when folded over in your mind’s eye the halves don’t match); change in color including presence of black, red or white colors; irregular rather than smooth rounded borders; moles that itch or bleed and, perhaps most important, moles that you are concerned about. Very often patients will point out lesions that bother them thouh they can’t say why. I teach my residents that those must be biopsied. Patients have  a sixth sense about their body and this must be respected by the doctor.

May Is Melanoma Awareness Month

The month of May has been designated MELANOMA AWARENESS MONTH. While the yearly calendar is packed full with days, weeks and months dedicated to many important medical and social causes, Melanoma Awareness Month is especially important and directly relates to activities we all participate in when the sun rises higher in the sky and the power of damaging ultraviolet radiation is more intense. More intense UV rays means more risk of skin damage from the cancer-causing mutations in the skin. Interestingly, ultraviolet radiation causes “fingerprint” mutations in certain cancer genes. The mutations are unique to the sun and so it is possible to identify in damaged skin, what mutations were accumulated while lying, working or playing in the sun unprotected. While not all melanomas are caused by the sun ( it is estimated that 40% of melanomas may not  be sun-related) the role of the sun in melanoma is well-established and that critical fact creates an opportunity for strategic protection. There are so many diseases and ailments for which the cause is not known. In the case of melanoma and skin cancer, we not only know the cause ( UV radiation) but we know how to minimize it, thus providing one true approach to preventative health. A great public service advertisement was recently posted on youtube.com:

http://www.youtube.com/watch?v=_4jgUcxMezM&feature=share

When Tattoos Are Not Forever

In an article this year in the Wall Street Journal by well-known health reporter Laura Johannes, Dr. Leffell was quoted on the subject of home removal treatments for tattoos.

“Where they are really effective, they are probably risky for home use. Where they are not risky, they are probably also less effective,” says David J. Leffell, a professor of dermatology at the Yale School of Medicine.

To read the whole article visit

http://online.wsj.com/article/SB10001424052748703652104576122291548909576.html