Posts for tag: chemotherapy

            Each year in the U.S. over 5.4 million cases of nonmelanoma skin cancer(NMSC) are treated in more than

3.3 million people.

           Each year there are more cases of skin cancer than the combined incidence of cancers of the breast,prostate,                                             

lung and colon and that over the past  3 decades more people have had skin cancer than all other cancers combined.

           According to the statistics basal cell carcinoma (BCC) is the most common form, of skin cance ( with more

than 4 million cases diagnosed in the U.S. annually,while squamous cell carcinoma( SCC) is the second most common

form-with more than 1 million cases diagnosed every year.

          However, I should like to point out that in my many years of practice,SCC has been far and away the most

common type of skin cancer diagnosed. And,in my opinion, SCC is harder to diagnose than BCC since it often

appears simply like dry skin areas and is easy to miss-unlike BCC which,in spite of the fact that there are several

different types,is easier to diagnose in my opinion.

         While actinic keratosis is the most common pre-cancerous skin lesion,about 90 % of NMSC are associated

with UV radiation from the sun. Other causes of skin cancer include  medical radiation ,chemotherapy (especially in already

immunosuppressed individuals suffering from internal cancer),non-healing ulcers,sores,vaccination marks and tatoos.

In addition,people drinking well water contaminated with arsenic from fertilizers used in sod farms,etc. are prone to

squamous cell carcinomas and if present in non-sun exposed areas of the skin can be more likely to spread

internally.

          Also, people who have had organ transplants have an incidence of squamous cell carcinoma about

100 X more than the general public-possibly due to the anti-rejection drugs (which depress the immune system)

they must take to prevent their body from attacking the  the organ transplant.

            One person dies of melanoma skin cancer every 54 minutes and that an estimated 87,000 + new cases of melanoma

will be diagnosed in the U.S.in 2017.And, that an estimated  9700 + will die of melanoma in 2017-the vast majority of which

are caused by the sun and that the risk of melanoma doubles if he or she has had more than 5 sunburns.

            And if you want to hear something really scarey,listen up: people who first use a tanning bed before age 35

increase their risk for melanoma by 75 %.

           In 2016 I diagnosed several people with malignant melanoma  over a six month period. My experience in

both internal medicine and dermatology over many years has been how certain diagnoses occur in clusters.

I could never figure out how as a young doctor working many a night in emergency rooms that one evening

everyone seemed to have chest pain,the next night breathing difficulty due to pulmonary problems,the next

night everyone needed sutures,the next night was pediatric night and on and on-almost as if there was a sign over the

emergency room entrance. 

           Even though I may not see a patient with malignant melanoma in many months,I know that if one

comes in,there will be at least 2 more in the near future since from my personal experience things seem to

always occur at least in 3's.

           It is also interesting to note that women aged 49 and under have a higher probability of developing

melanoma tha any other cancer except breast and thyroid cancer.

          And,it is very important to note that in darker skinned people such as blacks,Asians,Filipinos,Indonesians

and native Hawaiians ,melanomas are more likely to occur on non-sun exposed areas such as the ano-genital

area,palms of the hands,soles of the feet,mucous membranes and fingernail and toenail areas. Therefore,it is

encumbent on the clinician to examine these areas.

          And,SCC,the most common skin cancer in black and Asian peoples,tends to be more aggressive

(perhaps,because of delayed diagnosis in non-sun exposed areas) in black people with a 20 to 40 % chance

of metastasis(spreading internally).

         And,although malignant melanoma accounts for only up to 3 percent of all pediatric cancers,its treatment

is often delayed due to misdiagnosis of pigmented lesions,which occurs up to 40 percent of the time.Parents

should ask their child's pediatrician for a sunscreen SPF recommendation.

         In conclusion, regular use of a sunscreen with an SPF of at least 30 applied at least 30 minutes before

exposure and reapplied after bathing and at least every 2 hours while avoiding excessive sun exposure

during the heat of the day 10 AM-4 PM can markedly cut the risk of skin cancer and show 24 percent less

skin aging than those who do not use sunscreens daily.

        Also,one should get regular skin exams and check their own skin on a regular basis and report any 

changes to their clinician.

         

 

           To begin with, the current shingles vaccine contains a live,attenuated (weakened)

virus which is only about 51 % effective in preventing shingles. Therefore,since it

contains a live virus,it should not be used in immunosuppressed individuals,ie,

people with cancer who are undergoing treatment with chemo or radiation therapy or

those with some other defect in their body's ability to fight infection.

            A newer vaccine under development,but not yet available,has about a 97.2 %

efficacy in preventing shingles and does not contain a live virus,and,ie,may be

appropriate even in immunosuppressed individuals.

            And, recent studies indicate shingles in immunocompetent people is

unlikely to recur and even if it does will probably be milder with less risk of

the very painful and often prolonged  post shingles pain known as post

herpetic neuralgia (if they are less than 80 years old).

           In addition,even though the risk of shingles in general is low in

otherwise healthy,elderly adults,physicians should remind patients who have

never had shingles to get vaccinated.

           However,the question now in my mind is should they risk shingles by

waiting for the new vaccine or get the older less effective vaccine now?-

again since it contains a live virus it is not for immunosuppressed individuals.

           And,if they elect  to get the older vaccine,will future studies

show increased shingles immunity and no untoward effects being revaccinated

with the newer more effective shingles vaccine when it becomes available ?

Coming soon.

The following list of medications is certainly not all-inclusive since many different classes of

prescription and over-the-counter drugs can make the skin more sensitive to ultraviolet rays.

Some of the more popular photosensitizing medications include:

          Antibiotics: tetracycline,doxycycline hyclate(not the smaller-dose doxycycline found

in the brand name product "Oracea.") and sulfa-containing antibiotics such as trimethoprim/

sulfamethoxazole.

         Arthritis drugs: ibuprofen, naproxen

        Blood pressure/"water pill" drugs: hydrochlorthiazide(more a blood pressure drug than

a water pill) furosemide(more a water pill than a blood pressure drug).Both of these contain

sulfa,which is a photosensitizer.

       A recent study indicated that the calcium channel blocker nifedipine and the ACE

inhibitor lisinopril both increased sun-sensitivity and made users more likely to develop

lip cancer.

       Diabetes drugs: glipizide,glyburide, and chlorpropamide all contain sulfa and,therefore,

are more likely to be sun-sensitizers.

      Antihistamine:  the popular diphenhydramine

     Acne medications: include those related to Vitamin A such as  isotretinoin,tretinoin,and

acetretin.

    Anti-cancer(chemotherapy) drugs:  5-fluorouracil  and dacarbazine

    Psychiatric drugs such as the major tranquilizers chlorpromazine and the tricyclic 

antidepressants  desipramine and imipramine.

   External (topical) products such as scented or deordorant soaps, toiletries, cosmetics or fragrances

         In summary,  the benefit of these drugs probably outweighs the potential sun-senitivity side

effects (especially with the judicious use of sunscreens and sun exposure time). If not,they

should only be discontinued with the consent of the health care practitioner prescribing

them.

 

 

 

              Most people beleve that skin cancer  is only caused by too much sun exposure resulting in 

many bad sunburns. However,skin cancer can also be caused by the damage to the skin resulting

from irradiation from  X-rays and from the injestion of arsenic salts.  People living near sod and turf farms

where arsenic is used in fertilizers have the risk of their well water being contaminated by

arsenic.Arsenic can result in a type of skin cancer called squamous cell carcinoma.

             In addition, scars,burns and vaccination marks can eventuate into skin cancer as well

as non-healing sores and ulers.

            I have forgotten the number of times patients with chronic ulcerated skin areas-especially

on their lower legs-and previously diagnosed as being caused by vascular problems came to

my office with squamous cell carcinomas  as now the predominant part of their skin ulcers.

            In addition,people with internal cancer being treated by chemo and/or radiation

therapy are immunosuppressed and have an increased risk of skin cancer.

           My senior citizen patients often ask me why they are getting skin cancer now 

when they  haven't had excessive sun exposure in many years.My answer: not only is

the effect of the sun cumulative over the years but also as all of us age our immune systems

become weaker and are not able to suppress the seeds of skin cancer sown many years

previously.

            The bottom line again: any change in size,color or shape of a skin lesion or any

non-healing sore or ulcer should be checked and probably biopsied by your health care

practitioner.



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