DermHelpCentral

3Derm

is an innovtive company that has created a system for diagnosing skin lesions with a specal emphasis on melanoma. They have developed a handheld skin imager and intuitive cloud-based software to take, store, and send clinical quality 3D images from any user to a trained dermatologist. Their imager matches or exceeds industry standards in lighting, polarization, and magnification - ensuring that every image taken with a 3Derm device is diagnostically useful. The 3Derm web platform was built from the ground up to be HIPAA secure, and allows patients and dermatologists to connect easily with a modern interface. These innovations are designed to improve access to and frequency of standardized skin imaging - detecting skin cancer at the earlier, more treatable stages.  See 3Derm Website.

Skin Cancer Screening (Australian Recommendations)

In 2010, almost 780 000 skin cancers were diagnosed and treated in Australia. Only 1% of these were invasive melanoma. The vast majority were nonmelanoma skin cancers (NMSCs) in people aged 60 years and over. Nonmelanoma skin cancers in Australia are now nearly seven times more common than all other cancers combined; approximately half of these are removed by general practitioners.

This is a valuable about skin cancer screening from a Professor of Dermatology at the University of Melbourne, Victoria, Australia.

For article with helpful tables:  Download Skin Cancer Screening Sinclair

Blink Power

BLINK is a checklist devised by Dr. Peter Bourne, an Australian skin cancer expert, to help patients and doctors  more easily decide what skin lesions need to be biopsied and which ones can be observed.  This posting is intended to inform patients so that they can be real partners in the process.  The handout has been created by Yoon Cohen, a medical student who plans a career in dermatology.  Please contact her with questions, comments and suggestions.  Email Y.C.

See the BLINK pdf: Download BLINK Patient Handout

BLINK Checklist

B (Benign): Is the lesion immediately recognizable as a common benign lesion?

If the answer is ‘yes’, no further action is required.

If the answer is ‘no’, then proceed to the following:

L (Lonely): Is the lesion the only one of its type on that region of the body?

 ‘Yes’ scores 1

I (Irregular): Is the lesion dermatoscopically irregular? An asymmetrical pigmentation pattern and more than one color?

‘Yes’ scores 1

N (Nervous and/or Change): Is the patient nervous that lesion may be a skin cancer? Does the patient, or another observer, feel that the lesion is changing?

‘Yes’ scores 1

K (Known clues): Does the lesion have any dermatoscopic clues to malignancy?

‘Yes’ scores 1

If the lesion scores 2 or more out of 4, it is recommended to be biopsied.

Yoon Cohen, a 4th year medical student from Maine produced this document

Skin Cancer Screening: The Facts

Sabrina Reid, a Williams College premedical student, brought this article to our attention.  "The U.S. Preventive Services Task Force (USPSTF) says there isn't enough evidence for or against the skin cancer checks during which you or your doctor looks for changes in the color, size and texture of skin growths.

"This task force makes recommendations about the effectiveness of medical treatments every five to seven years to U.S. primary-care doctors. When it reviewed the latest data on whole body exams, the panel didn’t find evidence that they reduced mortality from skin cancer or the disease's spread. And it found that there are few studies of how accurately docs identify suspicious moles in real patients, rather than in photos. The task force recommends better research.

"There isn’t consensus about whether screening is beneficial or not. And there isn’t consistency about how frequently or which populations" should get checked, Wolff tells ScientificAmerican.com. "It points to the limited evidence in this area."

[Of course, this holds true for other screenings as well.  It is also unclear if colonoscopy is any better than tests for stool ocult blood -- but your gastroenterologist will lead you to think differenctly.  PSA is not recommended as a screening test for men over age seventy.  Caveat emptor.  Remember,  "Every peddler praises his needles."

Dysplastic (Atypical) Nevi

Atypical moles and dysplastic nevi are acquired melanocytic lesions of the skin whose clinical and histologic definitions are controversial and still evolving. Numerous definitions and criteria have been proposed, including the use of the term "atypical moles" for clinically abnormal nevi and "dysplastic nevi" for histologically abnormal nevi. Unfortunately, when clinically abnormal nevi are evaluated histologically, some studies have shown a lack of concordance, with some clinically abnormal nevi having no dysplastic features and some normal-appearing nevi having some dysplastic features.
For a good discussion see: ATYPICAL MOLE in eMedicine.com.

The term "Ugly Duckling" was proposed in 1998 by two French dermatologists to help observers discern those nevi which are worrisome. The UGLY DUCKLING (UD) is the one that is not like his brothers. 
Nevi in patients generally resemble each other.  UD nevi stand out and can be identified by dermatologists, indeed by most observers.  These lesions require attention and possibly biopsy.

A recent article in the Archives of Dermatology, "The "ugly duckling" sign: agreement between observer" discussed the utility of Dermoscopy in helping to diagnose worrisome moles.  It can be found here in pdf: Download dysplastic_nevus.pdf

Another important article on Atypical Nevi appeared in the European Journal of Dermatology in 2006:Download burgdorf_pdf.pdf It is a bit on the long side, but worth reading for anyone who wants to learn about this topic.

How to Examine Your Skin

HOW TO EXAMINE YOUR SKIN
Don't Be Shy!
(This was adapted from the website of  Dr. Norman Goldstein of Honolulu.  Dr. Goldstein is one of the foremost proponents of skin self-examination and the dermatologist who coined the phrase "Practice Safe Sun."

[Also see the file called:  "The Skin Exam: Why?" in this section.

Careful examination of your skin every month will improve your chances of finding early warning signs of skin cancer. This is especially important if:

You have fair skin and sunburn easily.

You have had several blistering sunburns.

You have had a lot of moles on your body.

You have a family history of skin cancer.

Examine your skin in a well-lighted room using a full length mirror and a smaller hand mirror. Undress completely and examine every inch of your skin, including hard to see places. Having someone else help you is important.

1. Examine your entire face including lips and eyelids. Inspect your scalp, neck, and tops of your ears.

2. Examine the front and back of your body. Raise your arms and look at your sides. Check the skin under your breasts.

3. Check all sides of your arms and hands, including between your fingers and fingernails.

4. Examine the back and front of your legs. Use the hand mirror to scan your buttocks and genitals.

5. Sit down to check your ankles and feet, including the soles and between your toes.

Contact your health care provides right away if you notice any changes in your skin such as a new mole or change in an existing mole.  Change is the most important factor to be aware of.

The Skin Check: WHY??

The .pdf document is more complete:  Download the_skin_check.pdf

The Skin Check

Julianne Anderson-Mann and David Elpern, M.D.

One of the most common dermatology office visits is for a patient who wants her or his “moles” checked.  The importance of this ritual is stressed in all the media; but few patients know what lesions to really worry about and who is really at risk.

There are some simple facts that may help you.  These are our opinions, formed from over 25 years of dermatology practice, but also idiosyncratic.

Who is at risk?
Light skinned whites have the greatest risk.   There are six skin types.  Of these Types I – II are most vulnerable to skin cancer. But, types III – IV can also develop skin cancer.  Cutaneous malignancies are much less common in types V – VI skin.

Skin Type                         Typical Features                                       Tanning Ability      
    I                   Pale white skin, blue/hazel eyes, blond/red hair      Always burns/never tans
    II                  Fair Skin, blue eyes                                                     Burns easily, tans poorly
    III                 Darker white skin                                                        Tans after initial burn
    IV                 Light brown skin                                                         Burns minimally/tans easily
     V                 Brown skin                                                                  Rarely burns, tans darkly
    VI                 Dark brown to black skin                                           Never burns, tans darkly

Common Skin Cancers
There are three common forms of skin cancer.
Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma (the most serious kind and the one most patients request skin checks for)

You can read about these at: DermNet NZ

Take-Home Messages
These are some of the important things that you should take away with you.

1.    Who makes the diagnosis of skin cancer?  (See Reference 1 for full information)
       In Men:      42% of dx are made by the patient
                        23% are made by the wife or girlfriend
                        35% by the physician

       In Women: 66% of dx are made by the patient
                         2% are made by the husband or boyfriend
                       32% by the physician

Stated differently, women find over 60% of self-detected lesions and over 95% of lesions discovered by a significant other.  This has profound implications.

Recently, we saw a Catholic priest for a lesion on his forearm.  A female parishioner said to him, “Father, you should get that spot on your arm looked at.”  It turned out to be an early melanoma.  It is clear is that women look at their partners differently than men.  Indeed, around 10 times as many skin cancers are discovered in men by their partners than in women by theirs.  I suspect that by making this information available some men may make an attempt to become better, more caring, observers.

2.    What makes a lesion worrisome?
Here one needs to consider appearance and behavior.  While appearance can be important, behavior trumps appearance.  The same holds for people.  Lesions that change over weeks to months are the most worrisome,  As a rule, lesions which change over a few days are more likely traumatic or inflammatory; while lesions that grow slowly over years are usually benign.  Of course, in medicine we say “never say never and never say “always.”  Usually, a changing lesion could mean a new lesion especially in an individual over age 30, or an evolving preexisting lesion.  Change over weeks to month is the most important historical fact that patients need to be aware of and that dermatologists should consider.  By listening to a patient who relates a change in a lesion (either a new one or a preexisting spot) it is possible to pick up melanomas and other skin cancer at very early stages when cure approaches 100%.

3.    The Sun.  The media demonizes ultraviolet light all the time.  Most patients feel guilty about the burns and tans they got as teenagers.  Some doctors scold patients about this, too.  We are not convinced that moderate sun exposure is all that bad; however, we are probably in the minority here.  Frankly, it is too boring to sing the same tune 20 – 30 time a day, particularly when there is no good evidence for this across the board.  Almost every white person got sunburns as a kid.  It’s a forgone conclusion that you might not have been as careful as you should have been.
Epidemiological research has shown that after age 20, ultraviolet light is not a big risk factor for melanoma.  For basal and squamous cell skin cancers, the more sun one gets the greater the risk.  But keep in mind that most of these latter two skin cancers types are relatively easy to treat if picked up early. The common exceptions are lesions in certain areas:  the nose, near the eyes and around the ears.
Dermatologists and sunscreen makers are obsessed with lathering on sunscreen every day.  This is a personal choice and it depends on your skin type and where you live:  the Northeast is not as “hazardous” as the South or Oceania.  We have a sunscreen handout if you want one.  It is in the Skin Cancer folder. 

4.    Family History. 
Nonmelanoma skin cancer (basal and squamous types) run in families.  If neither of your parents had these, your risk is to develop one is less. 
Melanoma also is more frequent if one has a first degree relative with a melanoma.  This is especially true if one has a first degree relative who developed a melanoma before age 40.   First degree relative means parent or sibling.  There are rare persons with uncommon familial melanoma syndromes who have two first degree relatives with melanoma and many atypical moles.  These individuals are at greatly elevated risk for melanoma, but these they are few in number.  We recommend a complete skin exam for everyone who has a first degree relative with melanoma.  In addition, a recent study has found that persons with a family history of melanoma have a higher rate of prostate, breast, and colon cancers, non-Hodgkin's lymphoma, and multiple myeloma2. These persons should be screened for these tumors as well.

Summary
These are some of the salient facts as we see it.  Other dermatologists may disagree.  Nothing is written in stone.  Some of these “facts” may change.  Remember, a skin scan is non-invasive and should be atraumatic.  It may help to bring your partner along with you since ideally at least 25% of skin cancers can be ideally found by a significant other.

Hopefully, this document will demystify the “Skin Check” and help you to understand which lesions are worrisome and what the risks are.  Please feel free to direct further questions to either of us.  Your feedback will help us to improve this handout.

References:
1. Who discovers melanoma? Patterns from a population-based survey.
Koh HK, Miller DR, Geller AC, Clapp RW, Mercer MB, Lew RA.
J Am Acad Dermatol. 1992 Jun;26(6):914-9.
Department of Dermatology, Boston University School of Medicine,
BACKGROUND: Melanoma is external and potentially detectable by many persons but little is known about who first discovers these lesions. An understanding of
discovery patterns can shape future public and professional education programs.
OBJECTIVE: Our purpose was to assess patterns of melanoma discovery and to
determine the patients' role in finding their own lesions. METHODS: With a
written, mailed questionnaire, we conducted a population-based statewide survey
of 216 incident cases of melanoma in Massachusetts. RESULTS: Approximately half
(53%) of melanomas were self-discovered, whereas the remainder were detected by
medical providers (26%), family members (17%), and others (3%). Nearly one third
of persons said they could not see their own lesions easily. Compared with men,
women were more likely to discover their own lesions (66% vs 42%, p = 0.001) and
those on their spouses (23% vs 2%, p less than 0.001). CONCLUSION: Improving
early detection and reducing mortality of melanoma will require both public and
professional education programs, with particular emphasis on targeting men at
highest risk of this disease.

2.  Population-Based Assessment of Non-Melanoma Cancer Risk in Relatives of
Cutaneous Melanoma Probands.
Larson AA, Leachman SA, Eliason MJ, Cannon-Albright LA.
J Invest Dermatol. 2006 Aug 10; [.
Using the unique Utah Population Database we examined risks for other cancers among relatives of 4,079 melanoma cases. Age- and sex-specific rates for 35 different cancer sites were calculated, and used to estimate relative risks among relatives. In
addition to the well-recognized risk for melanoma among first-degree relatives,
we found significantly increased risks for prostate, breast, and colon cancers,
non-Hodgkin's lymphoma, and multiple myeloma, ranging from 32 to 72% increased
risk.  Among second-degree relatives, in addition to increased risk for melanoma,
we identified significantly increased risks for prostate cancer and multiple
myeloma (27 and 53% increase, respectively). Among first-degree relatives of
melanoma cases diagnosed before the age of 40 years, we found significantly
elevated risks for cutaneous melanoma (380% increase) and prostate cancer (83%
increase). Significantly increased risks for prostate cancer and multiple
myeloma in both first- and second-degree relatives of melanoma cases are
suggestive of heritable cancer syndromes. The increased risks for five
additional cancer types in first-degree relatives of melanoma cases suggest that
individuals with a family history of melanoma should strictly adhere to
recommended screenings for all cancers.