Tag Archive for: skin cancer

Advanced Non-Melanoma Skin Cancer Patient Follow-Up Visit Planner

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Advanced Non-Melanoma Skin Cancer Care Partner First Office Visit Planner

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Advanced Non-Melanoma Skin Cancer Care Partner Follow-Up Visit Planner

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Advanced Non-Melanoma Skin Cancer Treatment Decisions: What’s Right For You? Resource Guide

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October 2021 Digital Health Roundup

The popularity of telemedicine is being embraced by insurance companies, and for now, the best place to identify skin cancer is still at the dermatologist’s office. Patients are concerned about privacy threats when it comes to technology in healthcare, and it turns out they have good reason to be. Fortunately, there are things being done to address the issue.

Privacy of Medical Records

A new survey shows that patients are concerned about privacy of medical records and the use of facial recognition technology in healthcare, reports upi.com. A large portion of the survey respondents perceive facial recognition technology as a privacy threat, but the use of the technology in healthcare has increased over the past few years as a way to prevent medical errors and provide extra security. With nearly 60 percent of respondents saying they are concerned about the security of these technologies, researchers are tasked with gaining public trust by increasing protections of healthcare information. Find more information here.

It seems that patients have reason to be concerned. Ransomware attacks are having negative effects on patient care, reports fiercehealthcare.com. A new report shows that ransomware attacks on healthcare organizations can lead to longer stays, delays in care leading to poor outcomes, and increases in patient transfers. The ransomware attacks are also linked to increased mortality rates. The report emphasizes the importance of increasing cybersecurity in healthcare to protect patients. Learn more about the report findings here.

Cybersecurity

Recognizing the cybersecurity vulnerabilities in healthcare, the U.S. Food and Drug Administration (FDA) recently released a best practices document as a resource for the healthcare industry, reports healthcareitnews.com. The document focuses on developing a cybersecurity communication strategy and offers aspects to consider in the event of a security breach. The FDA also plans to address medical device vulnerabilities so that patients who are dependent on medical devices will know what kinds of questions to ask their healthcare providers regarding the security of their devices. Get more information here and see the FDA best practices document here.

The U.S. Government is also investing in the future of information technology in public health, reports thehealthcaretechnologyreport.com. The Office of the National Coordinator for Health Information Technology (ONC) has an initiative that will help to develop the health information technology workforce and will help to increasing the number of workers in the field from underrepresented communities. With funding from the American Rescue Plan, ten universities that serve diverse communities have cooperative agreements to build up the healthcare technology workforce over the next four years. Learn more about the initiative and the ten institutions that are participating here.

Skin Cancer App Fails

A setback for healthcare technology occurred recently when a flaw in a direct-to-consumer app used to detect skin cancer was identified at a European annual meeting of dermatology, reports medicalxpress.com. Researchers found that the app, which is available in Europe, incorrectly classified more than 60 percent of benign lesions as cancerous, and almost 18 percent of Merkel cell carcinomas and almost 23 percent of melanomas as benign. The problem appears to be that the app depends on available images to determine the status of a lesion, but there are not enough images of rare skin cancers available for better accuracy. Find more information here.

Telemedicine

If you love virtual visits to the doctor, you are in luck! Insurers are now offering new types of health coverage specifically for telemedicine, reports modernhealthcare.com. Some insurance companies have plans that require online visits for nonemergency care. The plans tend to have lower premiums and patients select a doctor for their virtual visits who can refer patients to in-person doctors within the network if needed. However, there is some concern that virtual care as the primary means of care may not be ideal. The concern is that things might get missed, like early signs of disease that a doctor would not be able to pick up on through a virtual visit. Learn more about the new type of insurance plans here.

Notable News July 2020

It seems like everyone is talking about the Broadway musical Hamilton this month, so let’s take a cue from A.Ham himself and rise up because sitting is proving, yet again, to not be so good for us. Also, not good yet again? Covid-19. It’s especially not good for people with cancer. What is good? Advances in cancer treatment and a blood test that delivers super early cancer detection.

PanSeer

PanSeer is a non-invasive blood test that can detect five types of cancer up to four years earlier than current methods of diagnosis, reports theguardian.com. The blood test is not a cancer predictor, but instead is finding cancers before they cause symptoms or are detected through other screening methods. The test is not able to indicate the type of cancer a patient has, but, with further research, shows promise for early, non-invasive diagnosis. You can learn more here and here.

Photodynamic Therapies

Also showing promise is research regarding skin cancer treatments that could be used to treat other types of cancer, reports medicalxpress.com. Photodynamic therapies (PDT) which use light to treat skin cancers by destroying cancerous and precancerous cells could possibly be used to treat other types of cancers thanks to the development of silica nanocapsules that can be used to convert near-infrared light to visible light. Right now, PDT only works if the tumors are on or under the skin because it works with visible light to activate medications that are injected into unhealthy tissue. However, since near-infrared light can get deeper into the tissues and then be converted into visible light by the silica nanocapsules, the treatment becomes more versatile. Learn more about the process here.

Good Diet Improves Treatment

Speaking of versatile, changing your diet could really help during breast cancer treatment, says cancernetwork.com. Recently reported study findings show that a fasting mimicking diet is safe and effective during chemotherapy in women with early breast cancer. The diet appears to have a positive effect on how well the cancer treatment works, and also reduces the side effects caused by the treatment. Basically, the research found that when fasting, there were less nutrients and insulin for the healthy cells to address, indicating the body should conserve energy and put healthy cells into maintenance mode. Chemotherapy targets rapidly dividing cells, so instead of attacking the less-active healthy cells, it would easily find the malignant cells which don’t pick up on body signals and continue to divide despite the fast. Fasting mimicking diets are low-calorie, low-protein, low-carbohydrate, high-fat diet plans that trick your body into thinking it is fasting. You can learn more about fasting mimicking diets and breast cancer treatments here and here.

Cancer and COVID-19

The sooner we can get a treatment for Covid-19, the better, but in the meantime, cancer patients need to be especially diligent about avoiding the virus. The longer you have had cancer, the higher your risk of a severe Covid-19 infection, says technologynetworks.com. Research has found that people who were diagnosed with cancer 2 years or more ago are more likely to have a severe Covid-19 infection. While there are not a lot of studies regarding cancer patients and Covid-19, one study of 156 cancer patients with confirmed Covid-19 infection showed that 22 percent of the patients died from the infection, and those who had been diagnosed two years or more prior to infection were at a higher risk of dying. Symptoms of Covid-19 can mimic cancer symptoms or the affects of cancer treatments, so it can be hard to diagnose Covid-19 in cancer patients, which could result in more severe infections or higher death rates. Learn more about the study here.

Activity Decreases Cancer Risk

Avoiding exposure to the coronavirus may keep some of us out of the gym, but we still need to get moving, otherwise we increase our risk of dying from cancer, reports medicalnewstoday.com. In a study where patient activity level was tracked through hip monitors, researchers found that the amount of time people are sedentary puts them at a higher risk for dying from cancer. Researchers also found that being physically active for 30 minutes a day decreased the risk of dying from cancer. Vigorous exercise decreased the risk 31 percent and light exercise decreased the risk 8 percent. The increased activity doesn’t have to be all at once, either. It can be as simple as standing for five minutes every hour while you are at work. Instead of thinking you must get out there and exercise for thirty minutes at a time, think, ‘sit less, move more,’ throughout your day. Find more information here.

Tests for Melanoma Skin Cancer

This resource was originally published by the American Cancer Society here.

Most melanomas are brought to a doctor’s attention because of signs or symptoms a person is having.

If you have an abnormal area on your skin that might be cancer, your doctor will examine it and might do tests to find out if it is melanoma, another type of skin cancer, or some other skin condition. If melanoma is found, other tests may be done to find out if it has spread to other areas of the body.

Medical history and physical exam

Usually the first step your doctor takes is to ask about your symptoms, such as when the mark on the skin first appeared, if it has changed in size or appearance, and if it has been painful, itchy, or bleeding. You may also be asked about your possible risk factors for melanoma skin cancer, such as your history of tanning and sunburns, and if you or anyone in your family has had melanoma or other skin cancers.

During the physical exam, your doctor will note the size, shape, color, and texture of the area(s) in question, and whether it is bleeding, oozing, or crusting. The rest of your body may be checked for moles and other spots that could be related to skin cancer (or other skin conditions).

The doctor may also feel the lymph nodes (small, bean-sized collections of immune cells) under the skin in the neck, underarm, or groin near the abnormal area. When melanoma spreads, it often goes to nearby lymph nodes first, making them larger.

If you are being seen by your primary doctor and melanoma is suspected, you may be referred to a dermatologist, a doctor who specializes in skin diseases, who will look at the area more closely.

Along with a standard physical exam, many dermatologists use a technique called dermoscopy (also known as dermatoscopy, epiluminescence microscopy [ELM], or surface microscopy) to see spots on the skin more clearly. The doctor uses a dermatoscope, which is a special magnifying lens and light source held near the skin. Sometimes a thin layer of alcohol or oil is used with this instrument. The doctor may take a digital photo of the spot.

Skin biopsy

If the doctor thinks a spot might be a melanoma, the suspicious area will be removed and sent to a lab to be looked at under a microscope. This is called a skin biopsy.

There are many ways to do a skin biopsy. The doctor will choose one based on the size of the affected area, where it is on your body, and other factors. Any biopsy is likely to leave at least a small scar. Different methods can result in different types of scars, so ask your doctor about scarring before the biopsy. No matter which type of biopsy is done, it should remove as much of the suspected area as possible so that an accurate diagnosis can be made.

Skin biopsies are done using a local anesthetic (numbing medicine), which is injected into the area with a very small needle. You will likely feel a small prick and a little stinging as the medicine is injected, but you should not feel any pain during the biopsy.

Shave (tangential) biopsy

For this type of biopsy, the doctor shaves off the top layers of the skin with a small surgical blade. Bleeding from the biopsy site is stopped by applying an ointment, a chemical that stops bleeding, or a small electrical current to cauterize the wound.

A shave biopsy is useful in diagnosing many types of skin diseases and in sampling moles when the risk of melanoma is very low. This type of biopsy is not generally used if a melanoma is strongly suspected unless the biopsy blade will go deep enough to get below the suspicious area. Otherwise, if it is a melanoma, the biopsy sample may not be thick enough to measure how deeply the cancer has invaded the skin.

Punch biopsy

For a punch biopsy, the doctor uses a tool that looks like a tiny round cookie cutter to remove a deeper sample of skin. The doctor rotates the punch biopsy tool on the skin until it cuts through all the layers of the skin. The sample is removed and the edges of the biopsy site are often stitched together.

Excisional and incisional biopsies

To examine a tumor that might have grown into deeper layers of the skin, the doctor may use an excisional (or less often, an incisional) biopsy.

  • An excisional biopsy removes the entire tumor (along with a small margin of normal skin around it). This is usually the preferred method of biopsy for suspected melanomas if it can be done, although this isn’t always possible.
  • An incisional biopsy removes only a portion of the tumor.

For these types of biopsies, a surgical knife is used to cut through the full thickness of skin. A wedge or sliver of skin is removed for examination, and the edges of the cut are usually stitched together.

“Optical” biopsies

Some newer types of biopsies, such as reflectance confocal microscopy (RCM), can be done without needing to remove samples of skin. To learn more, see What’s New in Melanoma Skin Cancer Research?

Biopsies of melanoma that may have spread

Biopsies of areas other than the skin may be needed in some cases. For example, if melanoma has already been diagnosed on the skin, nearby lymph nodes may be biopsied to see if the cancer has spread to them.

Rarely, biopsies may be needed to figure out what type of cancer someone has. For example, some melanomas can spread so quickly that they reach the lymph nodes, lungs, brain, or other areas while the original skin melanoma is still very small. Sometimes these tumors are found with imaging tests (such as CT scans) or other exams even before the melanoma on the skin is discovered. In other cases, they may be found long after a skin melanoma has been removed, so it’s not clear if it’s the same cancer.

In still other cases, melanoma may be found somewhere in the body without ever finding a spot on the skin. This may be because some skin lesions go away on their own (without any treatment) after some of their cells have spread to other parts of the body. Melanoma can also start in internal organs, but this is very rare, and if melanoma has spread widely throughout the body, it may not be possible to tell exactly where it started.

When melanoma has spread to other organs, it can sometimes be confused with a cancer starting in that organ. For example, melanoma that has spread to the lung might be confused with a primary lung cancer (cancer that starts in the lung).

Special lab tests can be done on the biopsy samples that can tell whether it is a melanoma or some other kind of cancer. This is important because different types of cancer are treated differently.

Biopsies of suspicious areas inside the body often are more involved than those used to sample the skin.

Fine needle aspiration (FNA) biopsy

FNA biopsy is not used on suspicious moles. But it may be used, for example, to biopsy large lymph nodes near a melanoma to find out if the melanoma has spread to them.

For this type of biopsy, the doctor uses a syringe with a thin, hollow needle to remove very small pieces of a lymph node or tumor. The needle is smaller than the needle used for a blood test. A local anesthetic is sometimes used to numb the area first. This test rarely causes much discomfort and does not leave a scar.

If the lymph node is just under the skin, the doctor can often feel it well enough to guide the needle into it. For a suspicious lymph node deeper in the body or a tumor in an organ such as the lung or liver, an imaging test such as ultrasound or a CT scan is often used to help guide the needle into place.

FNA biopsies are not as invasive as some other types of biopsies, but they may not always collect enough of a sample to tell if a suspicious area is melanoma. In these cases, a more invasive type of biopsy may be needed.

Surgical (excisional) lymph node biopsy

This procedure can be used to remove an enlarged lymph node through a small incision (cut) in the skin. A local anesthetic (numbing medicine) is generally used if the lymph node is just under the skin, but the person may need to be sedated or even asleep (using general anesthesia) if the lymph node is deeper in the body.

This type of biopsy is often done if a lymph node’s size suggests the melanoma has spread there but an FNA biopsy of the node wasn’t done or didn’t find any melanoma cells.

Sentinel lymph node biopsy

If melanoma has been diagnosed and has any concerning features (such as being at least a certain thickness), a sentinel lymph node biopsy (SLNB) is often done to see if the cancer has spread to nearby lymph nodes, which in turn might affect treatment options. This test can be used to find the lymph nodes that are likely to be the first place the melanoma would go if it has spread. These lymph nodes are called sentinel nodes (they stand sentinel, or watch, over the tumor, so to speak).

To find the sentinel lymph node (or nodes), a doctor injects a small amount of a radioactive substance into the area of the melanoma. After giving the substance time to travel to the lymph node areas near the tumor, a special camera is used to see if it collects in one or more sentinel lymph nodes. Once the radioactive area has been marked, the patient is taken for surgery, and a blue dye is injected in the same place the radioactive substance was injected. A small incision is then made in the marked area, and the lymph nodes are then checked to find which one(s) became radioactive and turned blue. These sentinel nodes are removed and looked at under a microscope.

If there are no melanoma cells in the sentinel nodes, no more lymph node surgery is needed because it is very unlikely the melanoma would have spread beyond this point. If melanoma cells are found in the sentinel node, the remaining lymph nodes in this area are typically removed and looked at as well. This is known as a lymph node dissection (see Surgery for Melanoma Skin Cancer).

If a lymph node near a melanoma is abnormally large, a sentinel node biopsy probably won’t be needed. The enlarged node is simply biopsied.

Lab tests of biopsy samples

Samples from any biopsies will be sent to a lab, where a doctor called a pathologist will look at them under a microscope for melanoma cells. Often, skin samples are sent to a dermatopathologist, a doctor who has special training in looking at skin samples.

If the doctor can’t tell for sure if melanoma cells are in the sample just by looking at it, special lab tests will be done on the cells to try to confirm the diagnosis. These might include:

  • Immunohistochemistry (IHC)
  • Fluorescence in situ hybridization (FISH)
  • Comparative genomic hybridization (CGH)
  • Gene expression profiling (GEP)

If melanoma is found in the samples, the pathologist will look at certain important features such as the tumor thickness and mitotic rate (the portion of cells that are actively dividing). These features help determine the stage of the melanoma (see Melanoma Skin Cancer Stages), which in turn can affect treatment options and prognosis (outlook).

Testing for gene changes

For some people with melanoma, biopsy samples may be tested to see if the cells have mutations (changes) in certain genes, such as the BRAF gene. About half of melanomas have BRAF mutations. Some drugs used to treat advanced melanomas are only likely to work if the cells have BRAF mutations (see Targeted Therapy for Melanoma Skin Cancer), so this test is important in helping to determine treatment options. Tests for changes in other genes, such as C-KIT, might be done as well.

A newer lab test known as DecisionDx-Melanoma looks at certain gene expression patterns in melanoma cells to help show if early-stage melanomas are likely to spread. This might be used to help determine treatment options. To learn more, see What’s New in Melanoma Skin Cancer Research?

Imaging tests

Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of the body. They are used mainly to look for the possible spread of melanoma to lymph nodes or other organs. These tests are not needed for most people with very early-stage melanoma, which is very unlikely to have spread.

Imaging tests can also be done to help determine how well treatment is working or to look for possible signs of cancer coming back (recurring) after treatment.

Chest x-ray

This test might be done to help determine if melanoma has spread to the lungs, although a CT scan of the chest (see below) is often done instead.

Ultrasound

Ultrasound uses sound waves to create images of the inside of your body on a computer screen. This test might be used to look at the lymph nodes near the tumor, especially if it’s not clear if they’re enlarged based on a physical exam. Ultrasound is typically fairly quick and easy to do, and it doesn’t expose you to radiation.

Ultrasound-guided needle biopsy: Ultrasound can also be used to help guide a biopsy needle into a suspicious lymph node.

Computed tomography (CT) scan

The CT scan uses x-rays to make detailed, cross-sectional images of your body. Unlike a regular x-ray, CT scans can show the detail in soft tissues (such as internal organs). This test can show if any lymph nodes are enlarged or if organs such as the lungs or liver have suspicious spots, which might be from the spread of melanoma.

CT-guided needle biopsy: CT scans can also be used to help guide a biopsy needle into a suspicious area within the body.

Magnetic resonance imaging (MRI) scan

MRI scans use radio waves and strong magnets instead of x-rays to create detailed images of parts of your body. MRI scans can be very helpful in looking at the brain and spinal cord.

Positron emission tomography (PET) scan

PET scan can help show if the cancer has spread to lymph nodes or other parts of the body. It is most useful in people with more advanced stages of melanoma.

For this test, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body.

PET/CT scan: Many centers have special machines that do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan.

Blood tests

Blood tests aren’t used to diagnose melanoma, but some tests may be done before or during treatment, especially for more advanced melanomas.

Doctors often test blood for levels of a substance called lactate dehydrogenase (LDH) before treatment. If the melanoma has spread to distant parts of the body, a high LDH level is a sign that the cancer may be harder to treat. This can affect the stage of the cancer (see Melanoma Skin Cancer Stages).

Other tests of blood cell counts and blood chemistry levels may be done in a person who has advanced melanoma to see how well the bone marrow (where new blood cells are made), liver, and kidneys are working before and during treatment.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: August 14, 2019 Last Revised: August 14, 2019

 

It’s NOT Just Skin Cancer…

Real patient experiences shared privately at www.TreatmentDiaries.com.  Read more, share if you like or join in the conversation.  Making sure you feel less alone navigating a diagnosis is important.  Connecting you to those who can relate and provide support is what we do.

I’m new to Treatment Diaries and since this is my diary, I want to share some thoughts that are now near and dear to my personal experience with this dreadful condition.  Let me start with what I’ve heard more times than I can count over the past decade and most often when sharing my Melanoma diagnosis with those who are uninformed.  It goes something like this – “What kind of cancer did you have?”  My response, “I was diagnosed with stage III Melanoma.”  The exchange – “Oh I think I’ve heard of that, it’s just skin cancer…right?”  In fact, I’ve had people tell me I was lucky to just have skin cancer.  Quite possibly the one thing you should consider never saying to someone with Melanoma.  Not only is it completely untrue it will do nothing to make the individual with the diagnosis feel any better about their situation.  The truth is, Melanoma is one of the deadliest forms of skin cancer.  It’s not just skin cancer.

So now that we are clear on it’s not just skin cancer, a few things I wish I would have known:

  • Research suggests that approximately 90% of melanoma cases can be linked to exposure to ultraviolet (UV) rays from natural or artificial sources, such as sunlight and indoor tanning beds.
  • However, since melanoma can occur in all melanocytes throughout the body, even those that are never exposed to the sun, UV light cannot be solely responsible for a diagnosis, especially mucosal and ocular melanoma cases.
  • Current research points to a combination of family history, genetics and environmental factors that are also to blame.
  • You can read this Melanoma Fact Sheet for more information!
  • Support for melanoma patients is incredibly important and connecting with those who relate brings much needed encouragement along with valuable insight.

Unlike other cancers, melanoma can often be seen on the skin, making it easier to detect in its early stages. Keeping track of the changes to your skin and seeing a dermatologist on an annual basis can be a lifesaving event. If left undetected, however, melanoma can spread to distant sites or distant organs. Once melanoma has spread to other parts of the body (known as stage IV), it is referred to as metastatic, and is very difficult to treat. In its later stages, melanoma most commonly spreads to the liver, lungs, bones and brain; at this point, the prognosis is very poor.  Again…it’s not just skin cancer.

Skin cancer comes in many forms and for numerous reasons.  Your job is to protect your skin.  Our skin is the biggest most vital organ we have to care for.  We can’t live without it nor can it be replaced.  It’s ours for as long as we live so we need to take the vitality of it seriously.  Stay out of the sun, look for changes and recurring issues to your skin even in areas that never see the sun, see a dermatologist on a regular basis and make sure to wear sunscreen all year around.  It’s not just skin cancer especially when it can kill you.  It’s a serious topic and I feel so very fortunate to be able to share my personal experience.  I hope to be a help to others newly diagnosed and an inspiration to those on the journey.  Let’s kick melanoma to the curb together…

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