Dermatology - Spring/Summer 2017 Newsletter

Skin Health F RO M TH E KI M B E R LY AN D E R I C J . WALD MAN D E PARTM E NT O F D E R MATO LOGY

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S PR I N G/SU M M E R 2017

Managing Nonmelanoma Skin Cancer Without Surgery

Nonmelanoma skin cancer is the most common form of cancer in the United States. Many people are familiar with the main types of nonmelanoma skin cancer—basal cell cancer and squamous cell cancer. Over the past three decades, more of these skin cancers have been diagnosed yearly than cancers of the breast, prostate, lung, and colon combined. continued on page 2

Photo by Philippe Vermès

By Orit Markowitz, MD, Director of Pigmented Lesions and Skin Cancer, Mount Sinai Doctors Faculty Practice; and Amanda Levine, MD, Clinical Research Fellow, Kimberly and Eric J. Waldman Department of Dermatology

Orit Markowitz, MD (right) examines an image produced by Optical Coherence Tomography with Clinical Research Fellow Amanda Levine, MD.

IN THIS ISSUE

Sun Protection for Children: Questions and Answers

By Lauren Geller, MD, Director of Pediatric Dermatology, Mount Sinai Doctors Faculty Practice

2 More on Managing Skin Cancer Without Surgery

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LAUREN GELLER, MD

Finally the sun is out, and warmer weather is here. Many parents have questions about the best ways to protect their children from the sun. We encourage good sun protection even at a young age, because sun damage to your child’s skin has long-term effects that include premature aging, wrinkling, freckling, uneven skin tone, and most importantly, skin cancer. The incidence of the most dangerous form of skin cancer, melanoma, has been increasing in young patients.

A recent study published in the Journal of Pediatrics found that the incidence of melanoma in children and adolescents increased by 2 percent per year between 1973 and 2009. continued on page 3

More on Sun Protection for Children: Questions and Answers

4/5 Thank you to Our Supporters in 2016

6 Beach Umbrellas Versus Sunscreen

Managing Nonmelanoma Skin Cancer Without Surgery continued from page 1

BEFORE

BEFORE

AFTER

AFTER

A patient requested noninvasive removal of a basal cell cancer on the tip of her nose that recurred years after surgical removal (before). Dr. Markowitz performed laser therapy with OCT guidance and was able to shrink the lesion with one treatment (after). A second laser treatment cleared the cancer.

Optical Coherence Tomography (OCT) demonstrates the extent of the patient’s basal cell cancer before and after one laser treatment.

Although we can reassure patients that nonmelanoma skin cancers are rarely life-threatening, unfortunately more than 80 percent of these lesions are in aesthetically important areas of the face, head, and neck—sites where surgery and subsequent scarring can affect a patient’s quality of life.

To obtain more information or to schedule an appointment, please call 646-535-3863 and request to speak with a Research Fellow who works with Dr. Markowitz.

Surgical excision is the traditional method of treatment. Experienced skin surgeons such as those at Mount Sinai Doctors Faculty Practice are able to remove nonmelanoma skin cancers successfully while minimizing scarring with Mohs surgery, a method that is microscopically controlled. For patients seeking an alternative to surgery, we now offer new methods that are designed to detect, shrink, and sometimes even clear cancerous growths without cutting the skin.

Skin Health FROM THE KIMBERLY AND ERIC J. WALDMAN DEPARTMENT OF DERMATOLOGY

Orit Markowitz, MD, helped to develop revolutionary techniques for managing skin cancer with noninvasive imaging. She was the founding President of the International Optical Coherence Tomography (OCT) Society, and she is a leader in the field of reflectance confocal microscopy (RCM). One of the most important features of skin imaging with OCT and RCM is that it is now possible to detect early nonmelanoma skin cancers without a surgical biopsy.

Susan V. Bershad, MD Editor Yvonne B. Meyers Managing Editor Mark G. Lebwohl, MD Sol and Clara Kest Professor The Kimberly and Eric J. Waldman Professor Chairman of The Kimberly and Eric J. Waldman

Using noninvasive imaging, Dr. Markowitz can outline the border of a cancerous growth and visualize up to two millimeters in depth to assess its full extent and to help predict the surgical outcome. She can also use this technology to treat nonmelanoma skin cancers using nonsurgical methods that include laser treatments, topical therapy, and oral medications to clear tumors or to shrink them prior to Mohs surgery. Noninvasive imaging methods then allow her to monitor the effectiveness of treatment.

Department of Dermatology President, Editorial Board Editorial Board Brian J. Abbitan, MD

Angela J. Lamb, MD

Tomlee L. Abraham

David S. Orentreich, MD

Douglas D. Altchek, MD

Jonathan P. Ungar, MD

Janet Nezhad Band

Stephen Vance Wall

Gervaise L. Gerstner, MD Patricia Wexler, MD Bruce E. Katz, MD

Victoria F. White

Alan Kling, MD

Any patient with a suspected or diagnosed nonmelanoma skin cancer can consider these noninvasive methods, which are especially desirable for tumors located on the face and other sites where surgery could result in an unsightly scar. The new options can also be beneficial for high-risk surgical patients, including frail or immunosuppressed patients and those with advanced tumors.

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Design Mount Sinai Health System Creative Department with Hallets Cove Studio Nameplate photo courtesy Mark R. Wick, MD

Sun Protection for Children: Questions and Answers continued from page 1 These are the questions I hear most often from parents and caregivers: Q: Is it all right for a teenager to use an Q: Which sunscreen should I use on indoor tanning salon? my child?

A: Indoor tanning at any age is highly A: Sunscreens are divided into those discouraged by dermatologists. There that are chemical blockers and those are common misconceptions that indoor that are physical blockers. Chemical tanning is a “safe” way to get a tan and blockers contain ingredients such as that getting a “base tan” is a good way to benzones that absorb ultraviolet (UV) prevent sunburn. Studies have shown radiation from the sun. In contrast, that the incidence and frequency of the usual ingredients in physical sun indoor tanning in the United States is blockers are inert minerals, usually Dr. Geller examines a patient’s moles using a zinc oxide and titanium dioxide, which dermatoscope. This is a painless procedure that high among teens, with roughly 20 percent reporting use of a tanning reflect or scatter UV rays. I recommend magnifies skin growths and helps visualize the area beneath the skin surface. bed at least once. Ultraviolet radiation physical blockers for infants and from indoor tanning is harmful. Tanning beds have been children and for those with sensitive skin. Potential side placed in the highest risk category of known human effects from chemical sunscreens are uncertain, and the carcinogens (cancer-causing substances) alongside ingredients can be irritating or cause an allergic reaction. smoking. Research clearly shows that indoor tanning, Adolescents and adults may use either physical sunscreens especially when used at a young age, significantly increases or chemical sunscreens, which tend to be lighter in texture the risk of melanoma and nonmelanoma skin cancer. and easier to apply. You’ll want to look for products that have a sun protective factor (SPF) of 30 or higher. Select a Q: What changes should I look for on my child’s skin? formula that provides “broad spectrum” coverage, meaning A: Parents should periodically look at their child’s skin at protection against both UVA and UVB radiation. home and see a dermatologist if they notice any changes.

Check new growths and moles for the ABCDEs of melanoma: Q: Do you recommend sunscreen sprays? asymmetry, border irregularity, color variation, diameter A: The Food and Drug Administration is still investigating greater than 6 millimeters, and an evolving or changing the safety and efficacy of sunscreen sprays. In my view, mole, such as one that is growing or bleeding. there is a risk of not applying enough sunscreen when using a spray. Physicians are also concerned about potential Children, like adults, should have skin examinations on side effects from inhaling aerosols. I recommend avoiding a regular basis—usually once a year—by a dermatologist, sunscreen sprays until further information is available. especially if there is a family history of dysplastic (unusual) moles, melanoma, basal cell cancer, or squamous cell cancer.

Q: How often do I need to apply sunscreen during the day?

A: Sunscreen should be applied 30 minutes before going outside and reapplied every two hours. Sunscreens are no longer allowed to state that they are “waterproof.” They CLINICAL TRIAL OPPORTUNITIES may be labeled as “water resistant” for either 40 minutes Over the past four decades, the Dermatology Clinical Research or 80 minutes. Look for an 80-minute water-resistant Program at Mount Sinai has conducted studies of almost every sunscreen when your child’s activities include water sports new treatment in our field. Currently we are seeking volunteers with the following skin problems: or heavy sweating, and reapply it after drying off.

• Acne in women • Alopecia areata • Atopic dermatitis (eczema) • Bullous pemphigoid • Ichthyosis vulgaris • Melasma (facial pigment)

Q: What else can I do to protect my child from the sun?

A: In addition to sunscreen, children should wear widebrimmed hats, sunglasses, and sun-protective clothing, such as Rash Guard shirts. It helps to stay in the shade or indoors during midday, when the sun’s rays are at peak intensity.

• Nail fungus infections • Pemphigus vulgaris • Psoriasis (all forms) • Vitiligo (loss of pigment) • Warts and plantar warts

For more information, please contact us at 212-241-3288.

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Skin Health SPRING/SUMMER 2017

How to Prevent Sunburn: Research On Beach Umbrellas and Sunscreen A new study published in the journal JAMA Dermatology answers the question: which works better to prevent sunburn, staying under a beach umbrella or applying sunscreen with a sun protection factor (SPF) of 100? Among 81 volunteers with fair to medium skin, 72 percent of those who relied on beach umbrellas, compared with 25 percent of those who used SPF 100 sunscreen, developed sunburn after three and a half hours on the beach in midday sun.

According to Aaron S. Farberg, MD, a co-author of the study and a resident physician in dermatology at the Icahn School of Medicine at Mount Sinai, “It is known that sunburn causes skin cancer. Our study revealed that although high-SPF sunscreen provided better protection than the shade of a beach umbrella, neither was completely effective. This highlights the importance of using a combination of practices that include applying sunscreen, seeking shade, and wearing hats, sunglasses, and protective clothing.”

F.Y.I. (For You Inside)

• Nonsurgical Skin Cancer Care

• Sun Protection for Children Q&A • New Clinical Trial Opportunities • Thank you to 2016 Supporters

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BOOK AN APPOINTMENT

To book a dermatology appointment at Mount Sinai Doctors Faculty Practice, please call 212-241-9728 or to book online, please visit: www.MountSinaiDermatology.com