DermHelpCentral

More on Sunscreens

The New York Times, today, had an article about new sunscreen regulations.  If one is interested in this topic, it's a good starting point.

Image from Times article

"Experts are urging people to limit their time in the sun, especially at midday, and protect their skin with hats, shirts and cover-ups instead of relying exclusively on sunscreen" See NY Times "New Rules for Sunscreens."

Comment: Please keep in mind that there is controversy as to whether the rising incidence of melanoma referred to in the Times article is related to sun exposure or the result of diagnostic drift.  Pathologists now call lesions melanoma where years ago they would have labeled the same lesions dysplastic moles.  Also, screening tends to increase melanoma incidence (see work of Sam Shuster).  Melanoma incidence is rising, but death rate not nearly as much.  This is a complicated topic that needs to be be addressed. Researchers' conflicts of interests should be clearly noted.  The heavy funding of The Skin Cancer Foundation by "industry" and the grants given to researchers muddy the waters.  "No one should enter the Temple of Science with the soul of a money changer."  Sir Thomas Browne

 

Isotretinoin and Teary Eyes

Isotretinoin and One Patient’s Teary Eyes:  “Please Listen or I’ll Cry”

By David J. Elpern, M.D. and a Person with Acne

Abstract:

A 56 year-old man on isotretinoin for acne for an acneiform eruption of face and back experienced excessive tearing of his eyes.  Being unfamiliar with this under-reported side-effect, it was not addressed by his physicians.  In his moving essay, he asks his physicians to listen more attentively to their patients’ complaints.

Full article: Download IJD Isotretinoin

Non-Melanoma Skin Cancer in the Elderly

If you or a family member are elderly and have a non-melanoma skin cancer (basal cell or squamous cell) aggressive treatment is often not indicated.  A recent article by E. Linos reports a study on this topic.

 As usual, this article is not available to the public at large, but Paula Spann has written an excellent synopsis in the NY Times: Low-Risk Skin Cancers Often Treated Too Aggressively in Elderly, Study Finds.

The synopsis can be quite simple.  It is often more important to treat the patient with the tumor, than the tumor the patient has.  If an individual has a limited life expectancy, many non-melanoma skin cancers can be monitored periodically rather than being treated.  This presupposes that the physician who is following the patient has expertise in the management of skin cancers. 

There are certain tumors in the elderly that should be treated, however.  These are the ones that are likely to cause pain or become management problems.  Sadly, doing something is more lucrative for physicians than simple observation.  If fee-for-service medicine was replaced by a salaried model, the end-point might be different.  This is not likely to occur.

Doing nothing is more difficult for physicians, because this can be perceived as neglect.  It is important to have open-ended discussions with the patient and, where appropriate, his/her family, so all parties are on the same page. 

“Treat the patient, not the tumor” is an important mantra for all care givers.

References:
Treatment of Nonfatal Conditions at the End of Life: Nonmelanoma Skin Cancer (Abstract only available)

Paula Spann's NY Times article in The New Old Age section of the NY Times.