USPSTF: Insufficient evidence for visual skin cancer screening

06 dec 2015—The U.S. Preventive Services Task Force has found that there is currently insufficient evidence to weigh the benefits and harms of visual skin cancer screening in adults. These findings form the basis of a draft recommendation statement published online Nov. 30 by the USPSTF.
Noting that an estimated 74,000 U.S. men and women will develop melanoma in 2015 and 9,940 will die from the disease, researchers from the USPSTF reviewed the evidence for the benefits and harms of visual skin cancer screening in adults.
The researchers found that visual skin examination by clinicians has modest sensitivity and specificity for detecting melanoma. However, the evidence is currently insufficient to assess the balance of benefits of visual screening. Adequate evidence suggests that visual skin cancer screening may lead to harms; the magnitude of these harms could not be quantified based on current data. Based on these findings, the USPSTF concluded that the current evidence is inadequate to determine the balance of benefit and harms of visual skin examination for asymptomatic adults.
"The Task Force is dedicated to helping Americans avoid skin cancer and lead healthy lives," Task Force member Michael P. Pignone, M.D., M.P.H., said in a statement. "Until we have more research to better understand the balance of benefits and harms of a clinical visual skin exam, we encourage patients to talk to their doctor about any concerns they have about their skin."
More information: Draft Evidence Review
Draft Recommendation Statement
Comment on Recommendation

AAD: Older men should screen themselves for skin cancer

Men aged 50 years or older are more likely to be diagnosed with invasive melanoma by a dermatologist than to detect it themselves; and they are less likely to seek a skin cancer screening due to a suspicious lesion, according to the results of two studies presented at the annual meeting of the American Academy of Dermatology, held from March 1 to 5 in Miami Beach.

02 mar 2013—Men aged 50 years or older are more likely to be diagnosed with invasive melanoma by a dermatologist than to detect it themselves; and they are less likely to seek a skin cancer screening due to a suspicious lesion, according to the results of two studies presented at the annual meeting of the American Academy of Dermatology, held from March 1 to 5 in Miami Beach.

Laura K. Ferris, M.D., from the University of Pittsburgh School of Medicine, and colleagues examined which patients detect their own melanomas before assessment by a dermatologist in a cohort of 167 patients diagnosed with melanoma. The researchers found that the patients discovered 60.5 percent of the melanomas, and that cases detected by the dermatologist were more likely in older patients. Men aged 50 years or older were more likely to be diagnosed with invasive melanoma by a dermatologist, compared with women in the same age group and younger men and women.

In a second study, to examine the impact of age and gender, Ferris and colleagues surveyed 478 adults who went for skin cancer screening by a dermatologist. The researchers found that men aged 50 years or older mainly sought a skin examination because they had had a previous diagnosis of skin cancer (64.6 percent). Compared with other patients, this group was less likely to seek a skin cancer screening because of a suspicious spot (11 versus 22.5 percent).

"Older men are most at risk for melanoma and are most likely to die due to a delayed diagnosis," Ferris said in a statement. "This should be a wake-up call to men over 50 and their loved ones."

More information: Press Release 
More Information

Two more genes linked to common skin cancer

13 oct 2008--Scientists have found two new genetic variations that appear to increase the risk of the most common skin cancer among people of European descent.
The variations play no role in skin color but people with both of them are nearly three times more likely to develop basal cell carcinoma compared with people without the changes, researchers from Iceland's Decode Genetics said on Sunday.
Darker skin is traditionally regarded as an important protection against skin cancer.
"Here we have two variants that have no impact on pigmentation and only affect the risk of basal cell carcinoma," Kari Stefansson, Decode's chief executive, who led the study, said in a telephone interview. "We don't know why that is."
Basal cell carcinoma is the most common form of cancer worldwide, and in the vast majority of cases are thought to be caused by exposure to ultraviolet rays of the sun, according to the American Academy of Dermatology.
Most cases are easy to treat when detected early, but in rare instances the cancer is resistant to treatment, causing damage to skin and sometimes invading bone and cartilage.
The researchers at Decode, a biotech company hunting for new drugs using Iceland's unique gene pool dating back to the Vikings, analyzed genes of more than 30,000 people to identify the impact of the genetic variations located on chromosome 1.
These variations differed from past genetic changes linked to basal cell carcinoma in that unlike the others they were not associated with fair skin or pigmentation.
The study published in Nature Genetics also found that the risk of developing basal cell carcinoma was 12 times higher for people with these new variations along with the three other genetic changes already linked to the cancer.
"Exposure to the sun has no direct impact on the genes, which add to the total risk of basal cell carcinoma," Stefansson said.
(Reporting by Michael Kahn; Editing by Charles Dick)

Virus May Cause Aggressive Merkel Cell Skin Cancer

By Crystal Phend
PITTSBURGH, Jan. 17 - The rare and often-deadly Merkel cell carcinoma may be induced by a polyomavirus, researchers here reported. DNA sequences of the newly discovered Merkel cell polyomavirus were detected in 80% of tumors but only 8% to 16% of controls, reported Patrick S. Moore, M.D., M.P.H., of the University of Pittsburgh, and colleagues online in Science."It's integrated in such a way that it looks like it was present before the tumor actually started growing," Dr. Moore said. "That at least gives us some evidence that the virus may play a role in this tumor."Merkel cell carcinoma is a neuroectodermal tumor arising from mechanoreceptor Merkel cells. Merkel cell carcinoma is the most aggressive form of skin cancer, and about half of advanced cases survive no more than nine months. There are about 1,500 cases in the United States a year, with frequency weighted toward immunosuppressed transplant and AIDS patients, similar to Kaposi's sarcoma.
The polyomavirus is very strongly associated with Merkel cell carcinoma, said Dr. Moore, but the causal role is not established.
This would be the second oncovirus discovered by the research group, which also uncovered Kaposi's sarcoma-associated herpesvirus in 1993, and if confirmed, would be the eighth human tumor virus found over the past 40 years.
"Because it's an immune-related tumor, we thought there's a good possibility that there might be a directly transforming tumor virus in this tumor that we could search for," Dr. Moore said.
Over the course of nearly a decade, he and colleagues sequenced the cancer's transcriptome, sequencing the RNA from the tumor, and then using their digital transcriptome subtraction technique to subtract all the sequences common to the human genome. This left a relatively small pool of candidate viral sequences.
Two sequences identified a virus similar to African green monkey lymphotropic polyomavirus and to human BK polyomavirus T antigen sequences.
Tissue samples from Merkel cell carcinoma tumors of 10 patients were compared with control samples from skin and other tissues from 59 patients without skin cancer and from skin and other skin tumor types from 25 immunocompetent and immunosuppressed patients.
Eight of the 10 Merkel cell cancer samples tested positive for the virus sequences.
Five gastrointestinal tract tissues among the 59 control tissues (8%, P<0.0001) were weakly positive for the virus as were four of the 25 (16%, P=0.0007) additional skin and non-Merkel skin tumor samples from immunocompetent and immunosuppressed patients.
The researchers confirmed that this virus was integrated into the tumor DNA. The pattern of integration indicated the virus had integrated at several chromosomal sites prior to clonal tumor growth, suggesting it was possible the virus caused the cancer, the researchers said.
"Merkel cell polyomavirus in Merkel cell carcinoma may have some parallels to high-risk human papillomavirus," they wrote, "which causes cervical cancer mainly after viral episome disruption and integration into the cervical epithelial cell genome."
Like HPV, it's likely that few people infected with the virus develop cancer, Dr. Moore said.
"We think that it is a common infection, meaning that perhaps something between 5% and 20% of people may harbor this infection," he said, "Only some cells are going to be infected and harboring this virus."
Mutation of the virus leading to integration into the Merkel cell genome would then further be required before the cell would be predisposed to cancer, he said.
The researchers said they also hope to apply their subtraction technique to other tumors that physicians have long suspected might have a viral etiology.
The researchers provided no information on conflicts of interest.
Primary source: ScienceSource reference:Feng H, et al "Clonal integration of a polyomavirus in human Merkel cell carcinoma" Science 2008; DOI: 10.1126/science.1152586.

Exercise, caffeine fight skin cancer

By RANDOLPH E. SCHMID, AP Science WriterMon Jul 30, 1:01 PM ET
Can adding a cup or two of coffee to the exercise routine increase protection from skin cancer? New research indicates that just might be the case.
The combination of exercise and caffeine increased destruction of precancerous cells that had been damaged by the sun's ultraviolet-B radiation, according to a team of researchers at Rutgers University.
Americans suffer a million new cases of skin cancer every year, according to the National Cancer Institute.
In mice there is a protective effect from both caffeine and voluntary exercise, and when both are provided — not necessarily at the same time — protection is even more than the sum of the two, said Dr. Allan H. Conney of the laboratory for cancer research at Rutgers.
"We think it likely that this will extrapolate to humans, but that has to be tested," Conney said in a telephone interview.
Nonetheless, he added, people should continue to use sunscreen.
Exposing the mice to ultraviolet-B light causes some skin cells to become precancerous.
Cells with damaged DNA are programmed to self-destruct, a process called apoptosis, but not all do that, and damaged cells can become cancerous.
The researchers report in Tuesday's issue of Proceedings of the National Academy of Sciences that they studied hairless mice in four groups. Some were fed water containing caffeine, some had wheels on which they could run, some had both and a control group had neither.
"The most dramatic and obvious difference between the groups came from the caffeine-drinking runners, a difference that can likely be attributed to some kind of synergy," Conney said.
Compared with the control animals, those drinking caffeine had a 95 percent increase in apoptosis in damaged cells. The exercisers showed a 120 percent increase, and the mice that were both drinking and running showed a nearly 400 percent increase.
Just what is causing that to happen is not yet clear, though the researchers have several theories.
"We need to dig deeper into how the combination of caffeine and exercise is exerting its influence at the cellular and molecular levels, identifying the underlying mechanisms," Conney said.
"With an understanding of these mechanisms we can then take this to the next level, going beyond mice in the lab to human trials," he said. "With the stronger levels of UVB radiation evident today and an upward trend in the incidence of skin cancer among Americans, there is a premium on finding novel ways to protect our bodies from sun damage."
Conney said the researchers were originally interested in the effects of green tea in preventing skin cancer and were doing tests on regular and decaffeinated teas.
They found the regular tea had an effect, but not the decaffeinated brew.
And, he said, researchers also observed that mice drinking caffeine were more active than those that didn't get it, so they decided to study the effects of exercise too.
They put running wheels into some of the cages. The mice "love to go on it," he said, and will jump on the wheels and run for several minutes, then get off for a while, and then get on and run some more.
And they found that both caffeine and exercise helped eliminate damaged skin cells, but the combination worked better than either alone.
"What we would like to see next is a clinical trial in people," Conney said.
Dr. Michael H. Gold, a Nashville, Tenn., dermatologist and a spokesman for the Skin Cancer Foundation, said he believes "the concept of systemic caffeine should be addressed further."
"I think the concept potentially has a lot of merit," he said in a telephone interview. But mice and humans are different and studies need to be done to be sure this also applies to people.
In the meantime, he said: "If you go outside, you have to wear a sunscreen ... it has to be caffeine and exercise with your sunscreen."
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Proceedings of the National Academy of Sciences: http://www.pnas.org