Summary by Dirk M. Elston, MD Skin Cancer Darrel S. Rigel, MD, New York University Medical Center, New York, NY, presented alarming data regarding the incidence of skin cancer in the United States. Roughly 1 in 5 Americans will develop skin cancer in their lifetime, and 1 in 71 will develop malignant melanoma. This year, 51,400 melanomas will be diagnosed, and the death rate from melanoma is increasing. Someone dies of melanoma every hour. A great victory for patients with skin cancer was won on July 19, 2001, when the Health Care Financing Administration announced that Medicare will cover the treatment of actinic keratoses (AKs) without restrictions. The destruction of AKs is the most common outpatient dermatologic procedure performed in the United States, but there was no uniform policy on Medicare coverage of the management of AKs. The recent decision was supported by educational efforts of the American Academy of Dermatology Association, state dermatologic societies, and patient advocacy groups. Sun protection is critical in our fight against skin cancer. Protective clothing, avoidance of midday sun, and sunscreens play a part in skin cancer prevention, but sunscreen failure is common. Sunscreen failure is often related to underapplication and the choice of a too-low SPF. Surprisingly, a study of 105 individuals found no difference in the frequency of sunburn between users of SPF 15 and SPF 30 sunscreens. The major determinant of burns was the frequency of sunscreen application. Those who applied sunscreen every 2 hours experienced fewer burns. This last point is particularly important to convey to our patients. Currently available sunscreens have a limited duration of efficacy, and frequent application remains critical to adequate sun protection. Future advances will improve our patients' choices for sun protection. These include the availability of better fabrics, improved sunscreen delivery systems, and detergents that improve the photoprotection offered by fabrics. Dr. Rigel noted that pilots have a risk of melanoma 15 times that of the general population.[2] Whether this risk relates to cosmic radiation or to sun habits during layovers remains to be determined. An increased risk of melanoma related to psoralen UVA (PUVA) therapy is noted after 15 years, and increases over time.[3] In the new millennium, we will have more options for treating our patients with skin cancer. Preliminary studies suggest that the treatment of AKs, Bowen's disease, and superficial basal cell carcinoma with imiquimod may be possible. Photodynamic therapy is a promising modality for Bowen's disease and basal cell carcinoma. Recommended margins for malignant melanoma have decreased as new information becomes available. Of note is the recent publication[4] of data demonstrating that for melanomas between 1 mm and 4 mm in depth, margins of 2 cm and 4 cm were associated with similar survival rates. Local recurrence remains a significant factor in determining outcome. Dr. Rigel discussed new technologies with the potential to improve our ability to diagnose and treat melanoma. Near-infrared light and visible light broken down by wavelength are promising new modalities for the imaging of pigmented lesions. Confocal laser microscopy offers the potential for in vivo recognition of the margins of amelanotic melanoma. It will take time for these technologies find their way into the dermatologist's office, but science advances quickly. As new technologies are refined and become affordable, some will become part of everyday practice. Arch Dermatol, 12/02 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.