Posts Tagged ‘squamous cell carcinoma’

Take Steps to Prevent Skin Cancer

Skin ExamI am a dermatologist in the Emory Clinic and my focus is medical dermatology with a monthly melanoma clinic. I see patients of all skin types but a large part of my practice is seeing patients for total body skin exams (TBSE). We recommend that patients with all skin types get a total body skin exam, but patients who have a family history of melanoma, atypical mole syndrome or non-melanoma skin cancer should be particularly proactive about scheduling their skin checks. As a broad rule, once a year skin checks should suffice. These checks become more frequent in patients who have a personal history of melanoma or non-melanoma skin cancer.

A skin exam entails wearing a gown at the dermatologist’s office and getting all parts of your skin looked at for moles that may appear abnormal or growths that may be non-melanoma skin cancers such as basal cell skin cancer or squamous cell skin cancer. If we see anything suspicious, the spot is biopsied, which involves removing a small sample of skin tissue. It takes five minutes or less to perform a biopsy and the results are usually available in a few days.

During this visit, we educate patients to be good about self-examination. I recommend that patients pick the first of every month and put it on their calendar to examine their skin head to toe. They should look for any changing moles or any new bumps that may have come up. It can be difficult to know what to worry about or not, but in general a melanoma can show up as a new mole or a changing or bleeding mole. A basal or squamous cell generally presents as a new bump or flat lesion that can bleed, or hurt, or just be new and growing. If you are worried about something, you should make an appointment to be checked by your dermatologist right away.

Sun protection is a big part of preventing skin cancers. The AAD (American Academy of Dermatology) recommends everyone use sunscreen that is broad spectrum (protects against UVA and UVB), has a sun-protection factor (SPF) of 30 or greater and is water resistant. And you need to apply an adequate amount of sunscreen for it to be effective: generally one ounce (enough to fill a shot glass) for the exposed parts of your body for each application. This needs to be repeated every 2 hours on continued sun exposure. Remember to apply sunscreen at least 15 minutes before going outdoors.

You can use any type of sunscreen that works for you, such as lotions, creams, gels, sticks or even sprays. Sprays, though, have the disadvantage of accidental inhalation and it’s sometimes hard to know when using a spray if you have applied an adequate amount.

Tanning bed use has been proven to increase the risk of melanoma and also accelerate photo-aging. It should be avoided at all cost. Sunbathing and a history of blistering sunburns also increase your risk of skin cancer. It is very important to avoid the sun between 10 am and 2 pm, when the rays are the strongest, and to use additional protective clothing such as long sleeved shirt, pants, a wide-brimmed hat and sunglasses.

As you get ready for fun summer weekends, here’s a checklist to help you prevent skin cancer: avoid the sun when it’s at its strongest, use sunscreen and protective clothing any time you are out in the sun, never use a tanning bed, and when in doubt, check it out! Schedule an appointment with a dermatologist along with your annual physical visit, and for accurate information about safe sun practices, check the AAD website.

About Dr. Bhandarkar

Sulochana Bhandarkar, MDSulochana Bhandarkar, MD, is an assistant professor of dermatology at the Emory School of Medicine. She completed her medical school education from her home country, India, at Kasturba Medical College in Mangalore, where she also did a three-year dermatology residency with a special interest in vitiligo, a condition affecting skin pigmentation. After moving to the U.S., she did a clinical research fellowship at the University of California San Francisco, as well as a melanoma research fellowship at Emory University. She did her residency in dermatology at Emory University and became a faculty member at Emory in 2011. Her clinical interests are vitiligo and melanoma.

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Sun Damage Lasts a Lifetime

Sun ProtectionAfter a long, rough winter, it feels good to put away the jackets and get out the swim gear. As a melanoma oncologist, the summer is a double-edged sword as it also means that many people will be out in the sun doing irreversible damage to their skin. Not only can sun safety decrease your risk of skin cancer, it also can help protect you from the visible signs of aging. Who doesn’t want less cancer and to look younger at the same time? Unfortunately, some people believe they need a good burn or base tan to start the summer. Hopefully, I can change your mind about this with some basic information about skin cancer and a few tips on enjoying the summer without increasing your risk of developing skin cancer (or more wrinkles).

Skin cancer affects over three million people each year, making it by far, the most common cancer. The three most common skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal and squamous cell cancers are the most prevalent and originate from keratinocytes. These cancers are often referred to as “non-melanoma skin cancers.” They affect a little over two million Americans each year, with 80 percent of these being basal cell cancers. Most non-melanoma skin cancers are caused by repeated exposure of the skin to ultraviolet rays (primarily UVA and UVB) from sunlight or from artificial sources such as tanning beds. These rays damage the DNA in skin cells and cause them to grow and divide unregulated, thus producing a cancer. These types of skin cancers tend to stay in the skin, and therefore very few patients will die from basal or squamous cell cancers. It is estimated that approximately 2,000 people die each year from non-melanoma skin cancers.

In contrast, melanoma is a cancer that originates from melanocytes that normally make pigment to protect the other layers of the skin from sun damage. Melanocytes can also make non-cancerous growths like moles. The American Cancer Society estimates approximately 76,100 new melanomas will be diagnosed in 2014 with 9,710 deaths from this disease, making it the most deadly form of skin cancer. Lifetime risk of melanoma in the U.S. is about 1 in 50, and notably it is one of the most common cancers in those younger than 30. When diagnosed early, surgery alone has excellent survival rates. In the past there were few long-term survivors from advanced cases of melanoma. Fortunately, many novel therapeutic agents are being developed that have transformed the treatment of more advanced stages of melanoma with five new agents approved by the FDA since 2011. All of these new drugs are changing the landscape of melanoma treatment and patients are now not only living longer, but also with better quality of life.

Though melanoma development is more multi-factorial than basal or squamous cell cancer development, it is still linked to UV exposure through sunlight or tanning beds. The best way to decrease one’s risk of skin cancer development is to avoid long exposures to intense sunlight and practice sun safety measures. When outside, I recommend the use of broad spectrum sunscreen (SPF 30 or higher), use of sun protective clothing such as sun shirts and board brim hats, and avoid direct exposure between 10AM and 2PM when the intensity of the rays is the strongest. Sunscreen should be applied about 20-30 minutes prior to going outside and reapplied approximately every two hours. Because this is difficult to do, even for myself, I recommend barriers like sun shirts or umbrellas over sunscreen if possible.

Keep in mind the sun damage that occurs now will be with you for the rest of your life, so please don’t forget your sun protective gear on your way out to enjoy the beautiful weather.

About Dr. Kudchadkar

Ragini Kudchadkar, MDRagini R. Kudchadkar, MD is an assistant professor in the Department of Hematology and Medical Oncology at the Winship Cancer Institute of Emory University. She specializes in cutaneous oncology with an emphasis on the development of clinical trials for patients with metastatic melanoma. Dr. Kudchadkar previously worked as an assistant member of the Department of Cutaneous Oncology at the H. Lee Moffitt Cancer Center in Tampa, Florida. In addition to her clinical practice, Kudchadkar is involved in research that focuses on signal transduction inhibitors for the treatment of metastatic melanoma with a secondary interest in rare cutaneous malignancies such as advanced merkel cell and basal cell carcinomas.

Kudchadkar graduated from the Emory School of Medicine in 2003 and completed her internal medicine residency at Emory in 2006. She pursued her hematology and medical oncology training at the University of Colorado in Denver, CO, where she also served as chief fellow.

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Genomic Testing for Lung Cancer: What Does it Mean for You?

Lung Cancer Awareness MonthYou may be surprised to learn that lung cancer is the leading cause of cancer deaths in both men and women in the United States.  However, in the past few years, tremendous progress has been made leading to improved outcomes for patients with lung cancer.  According to the Centers for Disease Control and Prevention, genomics is “the study of all the genes in a person, as well as the interactions of those genes with each other and a person’s environment.”  While 99.9% of everyone’s genetic makeup is identical, the difference in the remaining 0.1% helps inform researchers about disease. For patients with certain subtypes of lung cancer, we have now made genomic testing of tumors a routine part of care.  Understanding that each person has a unique genetic makeup allows for individualized treatment for patients with specific mutations in their tumor tissues.

Lung cancer is broadly divided into two types: non-small cell lung cancer and small cell lung cancer.  Approximately 85% of lung cancers are of the non-small cell lung cancer category, which consists of three major subtypes: adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Adenocarcinoma accounts for nearly 50% of all non-small cell lung cancers and has had an increasing rate of incidence in the United States over the past few years. During the same time, we have learned a lot about the biology of lung cancer overall. As a result, sophisticated tests are now available to identify specific mutations in tumors of patients with adenocarcinoma of the lung.  For example:

  1. A gene called epidermal growth factor receptor (EGFR) is mutated in nearly 15% of patients with adenocarcinoma.  After years of research, we now know that treatment for these patients involves an orally administered targeted drug, versus combination chemotherapy. These novel treatments result in significant improvement of symptoms, disease control and survival.
  2. Through other research, we now know that another group of patients with adenocarcinoma carries a mutation in a gene called ALK.  For these patients, an FDA-approved treatment option named crizotinib is used, which has been found to provide great benefits to these patients.

Since it has been identified that a person’s genetic makeup plays a significant role in not only understanding their overall health and disease occurrence, but also the ideal treatment method(s) they should receive, nowadays, almost every patient diagnosed with lung adenocarcinoma is genetically tested for specific mutations. The good thing about this test is that it can usually be performed from already collected specimens used to diagnose lung cancer, therefore eliminating the need for additional invasive procedures.

Highlights of this post

At the Winship Cancer Institute of Emory University, we have implemented a standardized molecular testing protocol for every patient diagnosed with lung adenocarcinoma.  As a result, in most circumstances, when an oncologist sees a patient for the first time, detailed molecular information is available on the tumor tissue, which helps inform treatment decisions.

Unfortunately, for certain mutations, there are currently no FDA-approved treatment options. Yet, as Georgia’s first and only National Cancer Institute –designated cancer center, Winship offers a number of innovative clinical trials for such patients, with the aim of identifying treatment options that provide the best likelihood of success.

Through research and clinical trials, investigators and physicians have discovered that understanding the genetic makeup of lung cancer patients is key. This knowledge allows for optimal, individualized treatment options that lead to overall improved outcomes for our patients.

Suresh Ramalingam MDAbout Dr. Ramalingam
Suresh Ramalingam, MD, is Associate Professor of Hematology and Medical Oncology and Director of the Translational Thoracic Malignancies Program for the Emory Winship Cancer Institute. He is a Georgia Cancer Coalition Distinguished Cancer Clinician and Scientist.

Prior to joining Emory, Dr. Ramalingam was at the University of Pittsburgh Cancer Institute. He specializes in lung cancer, esophageal cancer and other thoracic cancers and is actively involved in the scientific development of novel anti-cancer treatment agents.

Dr. Ramalingam serves as the principal investigator on several early phase clinical trials in lung cancers, many of which are sponsored by the NCI.  He is widely published in peer-reviewed scientific journals and serves as a reviewer for a number of medical journals.  Dr. Ramalingam is a member of the Thoracic Core Committee of the Eastern Cooperative Oncology Group and serves on the editorial board of the journal Clinical Lung Cancer.

He earned his medical degree at the University of Madras in India, and served as chief medical resident in Internal Medicine at Wayne State University in Detroit.  He later conducted his fellowship in hematology and oncology at the University of Pittsburgh Cancer Institute.

Dr. Ramalingam is a recipient of the prestigious “Clinical Research Career Development Award,” which is presented by the American Society of Clinical Oncology. He has been selected as one of “The Best Doctors in America” and has received numerous awards of excellence such as The University of Pittsburgh Leadership Award for Excellence in Clinical Trials Program Development.

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