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Lasers in melanoma careLaser for melanoma in situ (MIS) should generally be reserved for nonsurgical, usually elderly patients. When indicated, MIS may be treated with CO2 laser or with combined Q-switched Nd:YAG and imiquimod. Any atypical-appearing lesion should be biopsied prior to the start of a laser treatment.
Sunlight and its effect on eye healthAvoiding sunlight entirely appears to be a misdirection. Melanoma is inversely related to latitude and inadequate acclimation (i.e., increased melanization and epidermal thickening), which carries the risk of both melanoma and non-melanoma skin cancer—common in northern latitudes.
Skin cancer advancesGenetic profiling is valuable in both diagnosis and prognosis of skin cancer. Hedgehog inhibitors and (superficial radiation therapy) SRT are strong contenders for treating nonmelanoma skin cancer. Advances in targeted therapies and biologics are part of the new wave of melanoma treatments.
Melanoma surgical management guidelinesAll surgical management of melanoma is defined by Breslow thickness. For melanoma less than 1 mm in thickness, typically a SLNB is not required. Future imaging devices may better delineate the extent and depth of the tumor in vivo.
Psoriasis and skin cancerCyclosporine and PUVA clearly increase the risk of squamous cell carcinomas, and there is evidence that TNF blockers and methotrexate may do so to a lesser degree. UVB phototherapy has not been shown to cause skin cancer. Acitretin offers protection against the development of basal cell and squamous cell carcinomas.
Genetic testing for melanoma riskPatients who carry a high-penetrance melanoma predisposition gene can often benefit from screening for other cancers. Patients who receive a positive genetic test result are more likely to embrace prevention and detection measures. A new “Rules of Three” proposes a point-based guideline to help determine who should be referred for genetic counseling and testing.
Melanoma staging updatesThe American Joint Committee on Cancer (AJCC) 8th Edition Melanoma Staging System includes important changes pertaining to T1 melanomas. The role of sentinel lymph node biopsy (SLNB) continues to evolve, particularly for thin melanomas. A contemporary international dataset is being applied to develop sophisticated and accurate personalized prognostic tools.
New challenges of melanomaMelanoma rates continue to rise, especially thin lesions which represents the largest group of fatalities. Gene expression profile tests can help diagnose or predict melanoma and are easy to use. But many dermatologists do not follow recommended treatment guidelines, which indicates a need to either educate practitioners or rethink the guidelines.
Diagnosing melanomaNewer tools to help diagnose challenging lesions include combined immunohistochemical stains and a growing array of genetic tests, one of which has shown the potential to gauge metastatic risk.
Motivating teens not to tan, on teens’ termsYou might be surprised about what researchers have uncovered about why teens tan. Having a better understanding of their motives, could help you help them.