DermHelpCentral

Melanoma on the Rise -- or is it being overdiagnosed?

An important article in the NY Times addresses a recent study on melanoma published from England.  It is important to read the Times piece and come to your own conclusions. Sadly, one of the American dermatologists who is quoted and who "pooh-poohs" the study is in the pay of sunscreen companies and a founder of the Skin Cancer Foundation which takes large sums from industry.

In recent years there has been a sharp rise in reported cases of malignant melanoma, the deadliest form of skin cancer. But a British study has found evidence that the epidemic may be due at least in part to “diagnostic drift,” a growing tendency to identify and treat benign lesions as malignant cancers. The findings may raise the temperature in an already-heated controversy.  Full Times article. 

Concerns Regarding Birth Control Pills

"The oral contraceptives Yaz and Yasmin are top-selling products, largely as a result of marketing that presents them as much more than mere pregnancy prevention. [Since they are commonly recommended to women with acne, it is in a patient's best interests to familiarize herself with the risks, even if they are small.]

Yaz, in particular, the top-selling birth control pill in the United States, owes much of its popularity to multimillion-dollar ad campaigns that have promoted the drug as a quality-of-life treatment to combat acne and severe premenstrual depression.

While the risk of blood clots is small, a patient needs to be aware of the data and make her own informed decision."  Reading this fine article:  Health Concerns Over Popular Contraceptives. 

For comparison of similar OCPs, click on image below:

Melanoma - Genetic Testing

It appears that routine genetic testing for persons at risk for melanoma is not, at present, the standard of care and may pose more uncertainties than help.  Things may change, but in 2009, this still appears to be valid.

Kefford RF, Mann GJ.  Is there a role for genetic testing in patients with melanoma?  Curr Opin Oncol. 2003 Mar;15(2):157-61.

Department of Medicine, Melanoma Genetics Research, Westmead Millennium Institute
for Cancer Research, University of Sydney at Westmead Hospital, Westmead, NSW,
2145, Australia. [email protected]

Autosomal dominant inheritance of mutations in the locus or the gene may confer a high risk of cutaneous melanoma development. The penetrance of mutations is influenced by UV exposure. Inherited variants in the melanocortin-1 receptor also confer increased risk of cutaneous melanoma. Features associated with increased genetic susceptibility to cutaneous melanoma include the presence of multiple affected first-degree relatives on one side of the family, multiple primary melanomas in the same individual, earlier age of onset, and the presence of multiple atypical nevi, but none of these factors reliably predicts for the presence of mutations. It is currently premature to offer predictive DNA testing  for melanoma outside of defined research protocols. This is because of (1). the low likelihood of finding mutations in known melanoma susceptibility genes, even in more than 60% of melanoma- prone kindreds; (2). the broad confidence limits on  current estimates of lifetime penetrance of mutations and the wide variation in this penetrance with locality; (3). a high "background" incidence of melanoma in non-mutation carriers in melanoma-prone families; (4). current uncertainties about the factors determining the functionality and phenotypic expression of the  trait among carriers of these mutations (penetrance), even if found; and (5). the lack of proved efficacy of melanoma prevention and surveillance strategies, even  for mutation carriers. Rather than singling out those deemed to be at high risk because of family history, all patients carrying risk factors for cutaneous melanoma should be subject to stringent programs of sun protection and skin surveillance.