There is NO reason to re-excise a moderately-atypical nevus

To those who are patients and those who follow my posts, you know that I am adamant that there has been an over-treatment of these atypical nevi for decades. In short, the data just does not support the removal of these lesions–PERIOD!

Another study was just completed at Emory University (Atlanta) and Atlanta Veterans Administration Medical Center. Here are their conclusions:

Re-excisions are not needed when clinically excised moderately dysplastic nevi have positive histologic margins, based on results of a retrospective study of 438 patients who were treated at nine academic medical centers in the United States. Not a single patient in the study developed melanoma at the excision site after an average follow-up of 6.9 years, and at least 3 years in all cases.     [SOURCE: Kim CC et al. IID 2018, Abstract 571.]

So when your Dermatologist or the Dermatopathologist (on their pathology report) states that your moderately atypical nevus should be removed, ask Why!

 

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Erectile dysfunction treatments lead to increased risk of melanoma and basal cell carcinoma.

The use of PDE5 inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are common for those with erectile dysfunction. More and more research has shown an increased risk of some types of skin cancer for those taking these medications. Interestingly, there have been no studies showing an increased risk of squamous cell carcinoma.

For this reason, those with a history of melanoma should take this into consideration when considering taking one of these medications. Those with a personal history of multiple dysplastic moles or family history of melanoma should also take this into consideration. For patients whom have had multiple basal cell carcinomas should also weigh the risks of taking these medications.

Melanoma: Lymph Node Dissection

Are we doing more harm than good? This has been a question that we have asked for decades regarding the treatment of malignant melanoma. Over the recent decades, margins of normal skin that are removed when treating melanoma have gotten smaller. Recently, the benefit of lymph node dissection to treat involved lymph nodes has come into question and has been recently studied.

According to a study published in the New England Journal of Medicine, patients with intermediate-thickness melanomas (1.2- to 3.5mm Breslow’s Depth) who were found to have a positive lymph node with sentinel lymph node biopsy (tumor in the lymph nodes), were not more likely to survive after having a lymph node dissection than not.

While removal of the lymph nodes resulting in better regional disease control, it did not increase melanoma-specific survival rates. In addition, patients whom have had lymph node dissection were more likely to have lymphedema (swelling).

SUMMARY:

What is clear is that early detection and treatment of melanoma is paramount to having a good outcome. Luckily, most melanomas grow laterally for years before they grow deeper. Increased patient awareness and education has resulted in earlier detection rates in the U.S. Unfortunately, once the tumor has spread, science has been unable to find a therapy that offers a “cure” for most patients. Medical advances have been made and may increase survival rates by 10% and continued research will likely improve upon these rates.

For all patients, early detection is key. Self-examination is recommended for patients. Any new or changing moles should be evaluated by a board-certified Dermatologist. “When in doubt, cut it out”–my slogan which means if there is a question of whether a lesion is melanoma, take a biopsy.

Patients whom have many moles should take photos and evaluate every 3 months for changes. There are several phone apps to assist with this.

“New” topical treatment for melanoma in situ: Not So Fast!

Melanoma in situ is a common tumor, and often affects the elderly. In some cases, surgery can be extremely extensive and/or patients are not good surgical candidates. For years, Dermatogists have been offering topical imiquimod (Aldara) to these patients as an alternative to surgery, with the full understanding that it is not as good as surgery, but better than nothing.

A recent study published in Dermatologic Surgery looked at long-term recurrence rates for patients who were treated with Aldara. They found that 17% of patients had a recurrence of their tumor, which is far higher than surgical recurrence rates.

In short, some publications talk about a “new” “alternative” to surgery. This is simply not the case. Surgery is the best option and topical treatment with imiquimod, as it has been, should only be considered for those who are not surgical candidates or those who are not expected to outlive their disease.

Tanning bed use for minors increases melanoma risk and death

A recent meta-analysis and data from the 2013 Youth Risk Behavior Survey concluded that prohibiting tanning bed use for minors could potentially reduce the incidence of melanoma by 4.9% and the number of melanoma deaths by 4.7%.

It has been long known that tanning bed use increases the risk of cancer, but these findings are quite alarming. A number of States have already made changes that prohibit minors from using tanning beds. Hopefully, other States follow suit.

New melanoma drug looks promising for Stage III and IV melanoma patients

51% Of Patients Benefited In Phase II Trial.

Forbes (10/30, Fortonbury) reports that in a study published in Annals of Surgical Oncology, a new cancer drug, PV-10,  51% of stage III and IV melanoma patients benefited during a phase II trial, and achieved total cancer disappearance in 26%. In addition, the response tended to be both rapid and dramatic, with a high rate of response. This drug is extremely promising and is much needed for the treatment of advanced melanoma.  Provectus Biopharmaceuticals, Inc. is the company that engineered PV-10.