Melanoma Developments

Melanoma is the most well known of the "bad" skin cancers. For decades the only proven treatment for melanoma was to cut it out when it was hopefully thin enough to metastasize, but now there is new evidence emerging that may eventually lead to improved ways of preventing the development before it ever develops. Additionally, two new treatments are promising for people whose melanomas were not found before spreading.

It is hard to believe, but good evidence that sunscreen prevents melanoma only emerged in the last year. Australian scientists gave some people sunscreen and told others to follow their normal sun practices. The people who wore sunscreen on a daily or near-daily basis developed 50% few melanomas than the people who used no other sunscreen.

Other interesting areas of prevention for melanoma include aspirin, ibuprofen and oral Vitamin D. Like with sunscreen use, people who took low-dose aspirin had half the melanoma risk of people who took a placebo. It is probably too early to say that people who take aspirin definitely have a lower risk, because this study was just the type that can establish an association, not a cause. We will probably have more clear recommendations in the next few years when the appropriate studies can be done.

The best treatment for melanoma is to catch it early and cut it out. If that does not work then some people get chemotherapy, but for decades the chemotherapy has been lousy, for lack of a better word. Two new medications, though, are bringing hope to people with advanced melanoma. One of the medicines, named ipilimumab, helps immune system cells "recognize" the melanoma. The other medication, vemurafenib, affects the melanoma cells directly by blocking an enzyme named BRAF (pronounced bee-raf), which makes the cells divide. Not all melanoma has that enzyme, but in the cancers that do, this medication has exciting potential. This is an exciting time to be treating patients with a disease that has been all but hopeless for my whole life.

Fillers: an introduction

Unfortunately, part of aging can include the loss of tissues of the skin and underneath the skin. When prevention with sunscreen was not enough one option for treating this type of aging includes fillers. The market for fillers has exploded in the last decade with new classes of fillers, each of which have strengths and weaknesses. Here are some thoughts on fillers:

1. Get fillers from a reputable dermatologist or plastic surgeon. Even a good filler in the wrong hands can cause problems including infection, lumps (called granulomas by dermatologists), and, of course, bad appearance. It is an unfortunate and not uncommon problem to see patients who had filler injections performed by poorly trained doctors with bad reactions like infection and granulomas. Some of the infections are easily treated by short courses of antibiotics but other infections with bacteria related to tuberculosis require years of treatment and/or surgical excision.

2. Different fillers are useful for different things (and have different risks). The materials commonly used to fill range from hyaluronic acid (a substance the body makes itself) to hydroxyapatite (one of the components of bone) to poly-L-lactic acid (basically liquid stitches like we would use as physicians). There are many other types of fillers, and there are things like silicone I do not think should ever be injected into skin for health reasons.

3. In skilled hands there are many possibilities with each of the fillers, and there is no single "best filler" for everything. In discussion with your dermatologist you can make a plan that fits your needs. In a nutshell, some of the hyaluronic acid fillers last not quite as long as the poly-L-lactic acid filler or the hydroxyapatite filler, but the body may be less likely to have a reaction to it. Also, there is an antidote—albeit an imperfect one—to hyaluronic acid fillers in case you do not like the results.



To summarize, if you think you are interested in a filler, talk to a dermatologist or plastic surgeon. Some doctors are more comfortable using some fillers over others. Steer clear of any doctor that offers you a "permanent" filler, or whose training is in question. In the right hands and for the right patient, however, fillers can enhance beauty and take away years of age.

What is Photoaging?

Believe it or not, the vast majority of the skin's changes related to aging are caused by the sun. The sun causes fine wrinkling like the "crow's feet" seen in this gentleman on the right. Wrinkling caused by the sun can range from lines seen only when the face is in motion to wrinkles seen at rest. Sun damage can culminate in normal smooth skin being completely replaced by wrinkles.

So how does the sun cause wrinkles? Ultraviolet-A but not ultraviolet-B light penetrates deep into the second layer of skin called the dermis, where it destroys the collagen and elastic fibers.

In addition to wrinkling, the sun is responsible for many of the pigment changes that come with aging. Most of these are called lentigos by dermatologists but are more commonly called liver spots. They range from light brown and small to large and quite dark. Rarely a lentigo can become cancerous requiring removal so if you havea brown lesion with multiple colors or enlarging or you have other concerns, see a dermatologist.

Another significant contributor to aging is the loss of fat under the skin. Some of this is due to the sun, but it can also be a part of "normal" aging. Interestingly, people with some conditions like diabetes tend to retain more of their fat under their skin later in life and it can help them appear younger than many of their non-diabetic counterparts.

So these are the basic types of aging, and they can each be treated. I will discuss treatments in detail in future posts, but in a nutshell there are many ways to treat all of them, but an ounce of prevention is worth a pound of cure so put on that sunscreen.

Have a great 4th of July!