Skin Cancer and Photoaging Update
February 2003
W e all know the dangers of the sun, but many are still ignoring the warnings and heading out in search of that “healthy glow” associated with tanning. Incidents of skin cancer continue to rise and patients are still turning to their dermatologists for treatment. The American Cancer Society estimated that 53,000 people had malignant melanoma last year, with 7,400 dying from the deadly form of skin cancer. Actinic keratosis, basal cell carcinoma and squamous cell carcinoma have also all continued to rise in incidence.
While the war against skin cancer seems daunting, there is hope in new and better treatments and stronger campaigns to teach the public about sun safety. From vaccines to better ultraviolet index guidelines much is being done in the way of education and research to help patients and physicians in the fight against skin cancer and photoaging. Here’s a look at some interesting news on these topics.
The Fight Against Malignant Melanoma
Vaccines may be the best bet.
L ast year, much research was done to determine the role of vaccines in preventing recurrences in patients with the deadliest form of skin cancer — advanced malignant melanoma. The vaccines have been designed to strengthen the immune system’s response to melanoma and its ability to kill or slow the cancer.
• In early January, Genzyme Molecular Oncology announced early, positive findings from Phase I/II trials of its cancer vaccine for melanoma. For these trials, investigators used two melanoma antigens in adenovirus vectors in a single vaccine.
Twenty-one patients were treated with a vaccine made up of two common viral vectors modified to express melanoma-specific proteins or antigens. The vaccine was injected into the patients’ immune-stimulating dendritic cells ex vivo in a cell processing facility and then injected back into the patient in a series of up to six vaccines. Fifteen of these patients showed evidence of clinical or immune responses. Of the three showing clinical responses, one sustained an ongoing pathologic complete response for more than 18 months, one showed a partial response, and one demonstrated stable disease for 10 months.
Overall results showed that eight patients had an immune reaction at the vaccination site, five experienced skin depigmentation and three exhibited asymptomatic changes in their retinas.
Researchers believe the results show that the vaccines stimulated patients’ immune systems in some manner, which makes them optimistic about the potential value of vaccines in treating cancer. Adverse effects were mild or moderate, according to Genzyme. Side effects reported in more than 10% of the patients included flu-like and flu-related symptoms.
The company says it plans to compare the results of this study with findings from its in vivo, antigen-specific melanoma trial using the same modified viral vectors, to determine the best way to advancing an antigen-specific product. Results are expected in this first half of this year.
• The December issue of the Journal of Clinical Oncology reported that a combined therapy of complete resection followed by active immunotherapy with the therapeutic vaccine Canvaxin, prolongs the life of patients with disseminated melanoma. Canvaxin, manufactured by CancerVax Corp., is an irradiated preparation of whole melanoma cells that induces a delayed-type hypersensitivity (DTH) response to important tumor antigens, according to the journal’s report.
Investigators looked at 263 patients who underwent complete resection of American Joint Committee on Cancer stage IV melanoma. The vaccine was given to 150 of these patients, while 113 didn’t receive vaccine therapy. Overall survival (OS) for the two groups was compared by COX regression and further analysis was done by matched-pair analysis according to the prognostic variables of sex, metastatic site and number of tumor-involved organ sites.
Results showed that 5-year OS rates for the vaccine treated group was 39%, and for the non-vaccine treated group it was 19%. On multivariate analysis, vaccine therapy was the most significant prognostic variable (P = 0.0001). Analysis of 107 matched pairs of vaccine and non-vaccine patients showed a significantly higher OS rate for vaccine therapy (P = 0.0009). There was a significant DTH response to adjuvant vaccine therapy (P = 0.0001) and OS was significantly correlated with DTH to vaccine (P = 0.0001), but not with DTH to purified protein derivative, a control antigen.
• Scientists at Harvard Medical School and Londons’ Hammersmith Hospital are researching the possibility that Listeria and E. coli could be used as anti-cancer vaccines to treat malignant melanoma, according to a recent Newsday report. The idea behind this vaccine, which has been tested in mice, is to eliminate the infectious properties of the bacteria and then join the two agents as a vaccine, which acts as an anti-cancer protein. E-coli invades cells and Listeria causes a condition called listeriosis by invading cells and causes lysing of host cells with a protein called listeriolysin.
In the study with mice that had malignant melanoma, the vaccine attacked the mice’s macrophages. These cells then attacked invaders anywhere in the body — in the mice, the macrophages attacked the injected cells. Also, the release of proteins from the vaccine stippled the surface of the macrophages, which called the immune system’s T-cells and B-cells. The result was that the mice with melanoma became cancer-free.
A pilot trial in people with melanoma is reportedly getting underway in London.
Should Melanoma Patients Worry About Surgeon’s Specialty?
A recent study found that the background of the physician performing definitive surgery for primary malignant melanoma doesn’t effect the outcome. The report, published in the November 30 issue of the British Medical Journal, studied 4,159 patients who had a primary melanoma removed sometime between 1979 and 1998. Surgeons who performed the surgery were grouped by specialties of dermatology, plastic surgery or general surgery. The researchers recorded age, sex, tumor thickness, presence of ulceration and maximum diameter of the primary tumor. The also looked at cause of death up to 1998.
An average of 10 years follow-up data was available on the patients studied, and researchers found no difference in surgery outcome based on surgeon specialty.
The results did show that dermatologists treated a significantly higher proportion of thin melanomas, while general surgeons treated more ulcerated melanomas. After adjustment for thickness, the dermatological surgeons saw the best outcome, but statistical significance was lost when adjustments were made for ulceration and for maximum diameter.
The study also found no evidence to prove that surgeons who had performed more excisions of primary melanoma had any better results than those who performed fewer excisions.
PDT and Laser Treatments for AKs
The latest results.
A t last year’s American Society for Dermatologic Surgeons meeting, Roy G. Geronemus, M.D., gave a presentation of a pilot assessment of a V-beam laser-assisted photodynamic therapy (PDT) for treating actinic keratoses (AKs), that he studied along with Macrene Alexiades-Armenakas, M.D., Ph.D..
In August 2002, Skin & Aging, reported on this study, in which Drs. Geronemus and Alexiades-Armenakas hoped to develop a PDT that would diminish pain, provide faster treatment and recovery times and give patients improved post-treatment cosmesis.
At that time, Dr. Geronemus shared the results from the 4-month follow-up of 40 patients aged 35 to 91 years with phototypes I-III. These patients all had one to 320 lesions on their heads, extremities and torsos. Each patient was assessed for lesion counts with photographs and skin biopsies after one treatment with PDT with aminolevulinic acid (ALA) and a pulsed dye laser.
Treatments included an application of a 20% solution of ALA on each individual lesion. Three to 14 to 20 hours later patients were treated with the V-beam laser (595 nm, 4 to 7.5 J/cm2, 10 ms, 10 mm, 30 ms cryogen/30 ms delay for pain relief).
The latest results show that for facial lesions, there was a 92% clearance rate at 4-month follow-up, 91% at 6 months and 90% at 8 months. Results are still showing that pain was nonexistent to reports of slight, erythema that was mild to moderate. In addition, patients didn’t experience crusting, purpura or scarring. About 60 lesions can be treated per minute with this modality, and recovery time is 1 to 2 days.
Preventing Skin Cancer
A look at the role of vitamins in skin care.
A study, done late last year, found that tazarotene (Tazorac), a vitamin-A prescription cream already used to treat acne and psoriasis, may also help prevent skin cancer in people with a family history of skin cancer, particularly basal cell carcinomas (BCC).
There was already evidence that prescription pills containing vitamin A derivatives, like isotretinoin (Accutane), can help shrink tumors, but doses necessary to treat skin cancer were too high with too many side effects. So Ervin Epstein Jr., M.D., studied the effects of newer retinoid creams like Tazorac on mice exposed to utlraviolet radiation three times per week for 11 months. Dr. Epstein, who presented his finding at the American Association for Cancer Research’s meeting last October, found that the mice treated with Tazorac showed an 85% decrease in the size and number of tumors. If other vitamin A derivatives show the same type of results, adding them to sunscreens may add more of an anti-cancer benefit.
Vitamin C and the Sun’s Damaging Effects
In addition to recommending that your patients wear sunscreen to help ward off the cancerous effects of the sun, you probably tell your patients that sunscreens will help protect them from photodamage as well. The March issue of Dermatologic Surgery reported that topical vitamin C can stimulate repair of photodamage to the skin with clinically and microscopically visible improvement.
Richard E. Fitzpatrick, M.D., and Elizabeth F. Rostan, M.D., performed a double-blind study in which 10 patients applied a vitamin C complex formulation consisting of 10% ascorbic acid (water soluble) and 7% tetrahexyldecyl ascorbate (lipid soluble) in an anhydrous polysilicone gel base. Patients applied the complex to half of their faces and an inactive polysilicone gel base to half.
Clinical evaluation of wrinkling, pigmentation, inflammation and hydration was performed before the studied started and again at weeks 4, 8 and 12. At the 12-week mark, 2-mm punch biopsies of the lateral cheeks were also performed for four patients and stained with hematoxylin and eosin. There were also in situ hybridization studies using an anti-sense probe for mRNA for type 1 collagen. All participants also completed a questionnaire.
Results showed statistically significant improvement of the cheeks (P=0.006) and the peri-oral areas (P=0.01) on the vitamin C-treated side. Overall facial improvement of the vitamin C side was statistically significant (P=0.01). Biopsies showed increased Grenz zone collagen and increased staining for mRNA for type 1 collagen. No patients reported any evidence of inflammation, and hydration was improved bilaterally. Four patients said the vitamin C side improved unilaterally, but none said the placebo side improved unilaterally.
W e all know the dangers of the sun, but many are still ignoring the warnings and heading out in search of that “healthy glow” associated with tanning. Incidents of skin cancer continue to rise and patients are still turning to their dermatologists for treatment. The American Cancer Society estimated that 53,000 people had malignant melanoma last year, with 7,400 dying from the deadly form of skin cancer. Actinic keratosis, basal cell carcinoma and squamous cell carcinoma have also all continued to rise in incidence.
While the war against skin cancer seems daunting, there is hope in new and better treatments and stronger campaigns to teach the public about sun safety. From vaccines to better ultraviolet index guidelines much is being done in the way of education and research to help patients and physicians in the fight against skin cancer and photoaging. Here’s a look at some interesting news on these topics.
The Fight Against Malignant Melanoma
Vaccines may be the best bet.
L ast year, much research was done to determine the role of vaccines in preventing recurrences in patients with the deadliest form of skin cancer — advanced malignant melanoma. The vaccines have been designed to strengthen the immune system’s response to melanoma and its ability to kill or slow the cancer.
• In early January, Genzyme Molecular Oncology announced early, positive findings from Phase I/II trials of its cancer vaccine for melanoma. For these trials, investigators used two melanoma antigens in adenovirus vectors in a single vaccine.
Twenty-one patients were treated with a vaccine made up of two common viral vectors modified to express melanoma-specific proteins or antigens. The vaccine was injected into the patients’ immune-stimulating dendritic cells ex vivo in a cell processing facility and then injected back into the patient in a series of up to six vaccines. Fifteen of these patients showed evidence of clinical or immune responses. Of the three showing clinical responses, one sustained an ongoing pathologic complete response for more than 18 months, one showed a partial response, and one demonstrated stable disease for 10 months.
Overall results showed that eight patients had an immune reaction at the vaccination site, five experienced skin depigmentation and three exhibited asymptomatic changes in their retinas.
Researchers believe the results show that the vaccines stimulated patients’ immune systems in some manner, which makes them optimistic about the potential value of vaccines in treating cancer. Adverse effects were mild or moderate, according to Genzyme. Side effects reported in more than 10% of the patients included flu-like and flu-related symptoms.
The company says it plans to compare the results of this study with findings from its in vivo, antigen-specific melanoma trial using the same modified viral vectors, to determine the best way to advancing an antigen-specific product. Results are expected in this first half of this year.
• The December issue of the Journal of Clinical Oncology reported that a combined therapy of complete resection followed by active immunotherapy with the therapeutic vaccine Canvaxin, prolongs the life of patients with disseminated melanoma. Canvaxin, manufactured by CancerVax Corp., is an irradiated preparation of whole melanoma cells that induces a delayed-type hypersensitivity (DTH) response to important tumor antigens, according to the journal’s report.
Investigators looked at 263 patients who underwent complete resection of American Joint Committee on Cancer stage IV melanoma. The vaccine was given to 150 of these patients, while 113 didn’t receive vaccine therapy. Overall survival (OS) for the two groups was compared by COX regression and further analysis was done by matched-pair analysis according to the prognostic variables of sex, metastatic site and number of tumor-involved organ sites.
Results showed that 5-year OS rates for the vaccine treated group was 39%, and for the non-vaccine treated group it was 19%. On multivariate analysis, vaccine therapy was the most significant prognostic variable (P = 0.0001). Analysis of 107 matched pairs of vaccine and non-vaccine patients showed a significantly higher OS rate for vaccine therapy (P = 0.0009). There was a significant DTH response to adjuvant vaccine therapy (P = 0.0001) and OS was significantly correlated with DTH to vaccine (P = 0.0001), but not with DTH to purified protein derivative, a control antigen.
• Scientists at Harvard Medical School and Londons’ Hammersmith Hospital are researching the possibility that Listeria and E. coli could be used as anti-cancer vaccines to treat malignant melanoma, according to a recent Newsday report. The idea behind this vaccine, which has been tested in mice, is to eliminate the infectious properties of the bacteria and then join the two agents as a vaccine, which acts as an anti-cancer protein. E-coli invades cells and Listeria causes a condition called listeriosis by invading cells and causes lysing of host cells with a protein called listeriolysin.
In the study with mice that had malignant melanoma, the vaccine attacked the mice’s macrophages. These cells then attacked invaders anywhere in the body — in the mice, the macrophages attacked the injected cells. Also, the release of proteins from the vaccine stippled the surface of the macrophages, which called the immune system’s T-cells and B-cells. The result was that the mice with melanoma became cancer-free.
A pilot trial in people with melanoma is reportedly getting underway in London.
Should Melanoma Patients Worry About Surgeon’s Specialty?
A recent study found that the background of the physician performing definitive surgery for primary malignant melanoma doesn’t effect the outcome. The report, published in the November 30 issue of the British Medical Journal, studied 4,159 patients who had a primary melanoma removed sometime between 1979 and 1998. Surgeons who performed the surgery were grouped by specialties of dermatology, plastic surgery or general surgery. The researchers recorded age, sex, tumor thickness, presence of ulceration and maximum diameter of the primary tumor. The also looked at cause of death up to 1998.
An average of 10 years follow-up data was available on the patients studied, and researchers found no difference in surgery outcome based on surgeon specialty.
The results did show that dermatologists treated a significantly higher proportion of thin melanomas, while general surgeons treated more ulcerated melanomas. After adjustment for thickness, the dermatological surgeons saw the best outcome, but statistical significance was lost when adjustments were made for ulceration and for maximum diameter.
The study also found no evidence to prove that surgeons who had performed more excisions of primary melanoma had any better results than those who performed fewer excisions.
PDT and Laser Treatments for AKs
The latest results.
A t last year’s American Society for Dermatologic Surgeons meeting, Roy G. Geronemus, M.D., gave a presentation of a pilot assessment of a V-beam laser-assisted photodynamic therapy (PDT) for treating actinic keratoses (AKs), that he studied along with Macrene Alexiades-Armenakas, M.D., Ph.D..
In August 2002, Skin & Aging, reported on this study, in which Drs. Geronemus and Alexiades-Armenakas hoped to develop a PDT that would diminish pain, provide faster treatment and recovery times and give patients improved post-treatment cosmesis.
At that time, Dr. Geronemus shared the results from the 4-month follow-up of 40 patients aged 35 to 91 years with phototypes I-III. These patients all had one to 320 lesions on their heads, extremities and torsos. Each patient was assessed for lesion counts with photographs and skin biopsies after one treatment with PDT with aminolevulinic acid (ALA) and a pulsed dye laser.
Treatments included an application of a 20% solution of ALA on each individual lesion. Three to 14 to 20 hours later patients were treated with the V-beam laser (595 nm, 4 to 7.5 J/cm2, 10 ms, 10 mm, 30 ms cryogen/30 ms delay for pain relief).
The latest results show that for facial lesions, there was a 92% clearance rate at 4-month follow-up, 91% at 6 months and 90% at 8 months. Results are still showing that pain was nonexistent to reports of slight, erythema that was mild to moderate. In addition, patients didn’t experience crusting, purpura or scarring. About 60 lesions can be treated per minute with this modality, and recovery time is 1 to 2 days.
Preventing Skin Cancer
A look at the role of vitamins in skin care.
A study, done late last year, found that tazarotene (Tazorac), a vitamin-A prescription cream already used to treat acne and psoriasis, may also help prevent skin cancer in people with a family history of skin cancer, particularly basal cell carcinomas (BCC).
There was already evidence that prescription pills containing vitamin A derivatives, like isotretinoin (Accutane), can help shrink tumors, but doses necessary to treat skin cancer were too high with too many side effects. So Ervin Epstein Jr., M.D., studied the effects of newer retinoid creams like Tazorac on mice exposed to utlraviolet radiation three times per week for 11 months. Dr. Epstein, who presented his finding at the American Association for Cancer Research’s meeting last October, found that the mice treated with Tazorac showed an 85% decrease in the size and number of tumors. If other vitamin A derivatives show the same type of results, adding them to sunscreens may add more of an anti-cancer benefit.
Vitamin C and the Sun’s Damaging Effects
In addition to recommending that your patients wear sunscreen to help ward off the cancerous effects of the sun, you probably tell your patients that sunscreens will help protect them from photodamage as well. The March issue of Dermatologic Surgery reported that topical vitamin C can stimulate repair of photodamage to the skin with clinically and microscopically visible improvement.
Richard E. Fitzpatrick, M.D., and Elizabeth F. Rostan, M.D., performed a double-blind study in which 10 patients applied a vitamin C complex formulation consisting of 10% ascorbic acid (water soluble) and 7% tetrahexyldecyl ascorbate (lipid soluble) in an anhydrous polysilicone gel base. Patients applied the complex to half of their faces and an inactive polysilicone gel base to half.
Clinical evaluation of wrinkling, pigmentation, inflammation and hydration was performed before the studied started and again at weeks 4, 8 and 12. At the 12-week mark, 2-mm punch biopsies of the lateral cheeks were also performed for four patients and stained with hematoxylin and eosin. There were also in situ hybridization studies using an anti-sense probe for mRNA for type 1 collagen. All participants also completed a questionnaire.
Results showed statistically significant improvement of the cheeks (P=0.006) and the peri-oral areas (P=0.01) on the vitamin C-treated side. Overall facial improvement of the vitamin C side was statistically significant (P=0.01). Biopsies showed increased Grenz zone collagen and increased staining for mRNA for type 1 collagen. No patients reported any evidence of inflammation, and hydration was improved bilaterally. Four patients said the vitamin C side improved unilaterally, but none said the placebo side improved unilaterally.
W e all know the dangers of the sun, but many are still ignoring the warnings and heading out in search of that “healthy glow” associated with tanning. Incidents of skin cancer continue to rise and patients are still turning to their dermatologists for treatment. The American Cancer Society estimated that 53,000 people had malignant melanoma last year, with 7,400 dying from the deadly form of skin cancer. Actinic keratosis, basal cell carcinoma and squamous cell carcinoma have also all continued to rise in incidence.
While the war against skin cancer seems daunting, there is hope in new and better treatments and stronger campaigns to teach the public about sun safety. From vaccines to better ultraviolet index guidelines much is being done in the way of education and research to help patients and physicians in the fight against skin cancer and photoaging. Here’s a look at some interesting news on these topics.
The Fight Against Malignant Melanoma
Vaccines may be the best bet.
L ast year, much research was done to determine the role of vaccines in preventing recurrences in patients with the deadliest form of skin cancer — advanced malignant melanoma. The vaccines have been designed to strengthen the immune system’s response to melanoma and its ability to kill or slow the cancer.
• In early January, Genzyme Molecular Oncology announced early, positive findings from Phase I/II trials of its cancer vaccine for melanoma. For these trials, investigators used two melanoma antigens in adenovirus vectors in a single vaccine.
Twenty-one patients were treated with a vaccine made up of two common viral vectors modified to express melanoma-specific proteins or antigens. The vaccine was injected into the patients’ immune-stimulating dendritic cells ex vivo in a cell processing facility and then injected back into the patient in a series of up to six vaccines. Fifteen of these patients showed evidence of clinical or immune responses. Of the three showing clinical responses, one sustained an ongoing pathologic complete response for more than 18 months, one showed a partial response, and one demonstrated stable disease for 10 months.
Overall results showed that eight patients had an immune reaction at the vaccination site, five experienced skin depigmentation and three exhibited asymptomatic changes in their retinas.
Researchers believe the results show that the vaccines stimulated patients’ immune systems in some manner, which makes them optimistic about the potential value of vaccines in treating cancer. Adverse effects were mild or moderate, according to Genzyme. Side effects reported in more than 10% of the patients included flu-like and flu-related symptoms.
The company says it plans to compare the results of this study with findings from its in vivo, antigen-specific melanoma trial using the same modified viral vectors, to determine the best way to advancing an antigen-specific product. Results are expected in this first half of this year.
• The December issue of the Journal of Clinical Oncology reported that a combined therapy of complete resection followed by active immunotherapy with the therapeutic vaccine Canvaxin, prolongs the life of patients with disseminated melanoma. Canvaxin, manufactured by CancerVax Corp., is an irradiated preparation of whole melanoma cells that induces a delayed-type hypersensitivity (DTH) response to important tumor antigens, according to the journal’s report.
Investigators looked at 263 patients who underwent complete resection of American Joint Committee on Cancer stage IV melanoma. The vaccine was given to 150 of these patients, while 113 didn’t receive vaccine therapy. Overall survival (OS) for the two groups was compared by COX regression and further analysis was done by matched-pair analysis according to the prognostic variables of sex, metastatic site and number of tumor-involved organ sites.
Results showed that 5-year OS rates for the vaccine treated group was 39%, and for the non-vaccine treated group it was 19%. On multivariate analysis, vaccine therapy was the most significant prognostic variable (P = 0.0001). Analysis of 107 matched pairs of vaccine and non-vaccine patients showed a significantly higher OS rate for vaccine therapy (P = 0.0009). There was a significant DTH response to adjuvant vaccine therapy (P = 0.0001) and OS was significantly correlated with DTH to vaccine (P = 0.0001), but not with DTH to purified protein derivative, a control antigen.
• Scientists at Harvard Medical School and Londons’ Hammersmith Hospital are researching the possibility that Listeria and E. coli could be used as anti-cancer vaccines to treat malignant melanoma, according to a recent Newsday report. The idea behind this vaccine, which has been tested in mice, is to eliminate the infectious properties of the bacteria and then join the two agents as a vaccine, which acts as an anti-cancer protein. E-coli invades cells and Listeria causes a condition called listeriosis by invading cells and causes lysing of host cells with a protein called listeriolysin.
In the study with mice that had malignant melanoma, the vaccine attacked the mice’s macrophages. These cells then attacked invaders anywhere in the body — in the mice, the macrophages attacked the injected cells. Also, the release of proteins from the vaccine stippled the surface of the macrophages, which called the immune system’s T-cells and B-cells. The result was that the mice with melanoma became cancer-free.
A pilot trial in people with melanoma is reportedly getting underway in London.
Should Melanoma Patients Worry About Surgeon’s Specialty?
A recent study found that the background of the physician performing definitive surgery for primary malignant melanoma doesn’t effect the outcome. The report, published in the November 30 issue of the British Medical Journal, studied 4,159 patients who had a primary melanoma removed sometime between 1979 and 1998. Surgeons who performed the surgery were grouped by specialties of dermatology, plastic surgery or general surgery. The researchers recorded age, sex, tumor thickness, presence of ulceration and maximum diameter of the primary tumor. The also looked at cause of death up to 1998.
An average of 10 years follow-up data was available on the patients studied, and researchers found no difference in surgery outcome based on surgeon specialty.
The results did show that dermatologists treated a significantly higher proportion of thin melanomas, while general surgeons treated more ulcerated melanomas. After adjustment for thickness, the dermatological surgeons saw the best outcome, but statistical significance was lost when adjustments were made for ulceration and for maximum diameter.
The study also found no evidence to prove that surgeons who had performed more excisions of primary melanoma had any better results than those who performed fewer excisions.
PDT and Laser Treatments for AKs
The latest results.
A t last year’s American Society for Dermatologic Surgeons meeting, Roy G. Geronemus, M.D., gave a presentation of a pilot assessment of a V-beam laser-assisted photodynamic therapy (PDT) for treating actinic keratoses (AKs), that he studied along with Macrene Alexiades-Armenakas, M.D., Ph.D..
In August 2002, Skin & Aging, reported on this study, in which Drs. Geronemus and Alexiades-Armenakas hoped to develop a PDT that would diminish pain, provide faster treatment and recovery times and give patients improved post-treatment cosmesis.
At that time, Dr. Geronemus shared the results from the 4-month follow-up of 40 patients aged 35 to 91 years with phototypes I-III. These patients all had one to 320 lesions on their heads, extremities and torsos. Each patient was assessed for lesion counts with photographs and skin biopsies after one treatment with PDT with aminolevulinic acid (ALA) and a pulsed dye laser.
Treatments included an application of a 20% solution of ALA on each individual lesion. Three to 14 to 20 hours later patients were treated with the V-beam laser (595 nm, 4 to 7.5 J/cm2, 10 ms, 10 mm, 30 ms cryogen/30 ms delay for pain relief).
The latest results show that for facial lesions, there was a 92% clearance rate at 4-month follow-up, 91% at 6 months and 90% at 8 months. Results are still showing that pain was nonexistent to reports of slight, erythema that was mild to moderate. In addition, patients didn’t experience crusting, purpura or scarring. About 60 lesions can be treated per minute with this modality, and recovery time is 1 to 2 days.
Preventing Skin Cancer
A look at the role of vitamins in skin care.
A study, done late last year, found that tazarotene (Tazorac), a vitamin-A prescription cream already used to treat acne and psoriasis, may also help prevent skin cancer in people with a family history of skin cancer, particularly basal cell carcinomas (BCC).
There was already evidence that prescription pills containing vitamin A derivatives, like isotretinoin (Accutane), can help shrink tumors, but doses necessary to treat skin cancer were too high with too many side effects. So Ervin Epstein Jr., M.D., studied the effects of newer retinoid creams like Tazorac on mice exposed to utlraviolet radiation three times per week for 11 months. Dr. Epstein, who presented his finding at the American Association for Cancer Research’s meeting last October, found that the mice treated with Tazorac showed an 85% decrease in the size and number of tumors. If other vitamin A derivatives show the same type of results, adding them to sunscreens may add more of an anti-cancer benefit.
Vitamin C and the Sun’s Damaging Effects
In addition to recommending that your patients wear sunscreen to help ward off the cancerous effects of the sun, you probably tell your patients that sunscreens will help protect them from photodamage as well. The March issue of Dermatologic Surgery reported that topical vitamin C can stimulate repair of photodamage to the skin with clinically and microscopically visible improvement.
Richard E. Fitzpatrick, M.D., and Elizabeth F. Rostan, M.D., performed a double-blind study in which 10 patients applied a vitamin C complex formulation consisting of 10% ascorbic acid (water soluble) and 7% tetrahexyldecyl ascorbate (lipid soluble) in an anhydrous polysilicone gel base. Patients applied the complex to half of their faces and an inactive polysilicone gel base to half.
Clinical evaluation of wrinkling, pigmentation, inflammation and hydration was performed before the studied started and again at weeks 4, 8 and 12. At the 12-week mark, 2-mm punch biopsies of the lateral cheeks were also performed for four patients and stained with hematoxylin and eosin. There were also in situ hybridization studies using an anti-sense probe for mRNA for type 1 collagen. All participants also completed a questionnaire.
Results showed statistically significant improvement of the cheeks (P=0.006) and the peri-oral areas (P=0.01) on the vitamin C-treated side. Overall facial improvement of the vitamin C side was statistically significant (P=0.01). Biopsies showed increased Grenz zone collagen and increased staining for mRNA for type 1 collagen. No patients reported any evidence of inflammation, and hydration was improved bilaterally. Four patients said the vitamin C side improved unilaterally, but none said the placebo side improved unilaterally.
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