Henry Ford Hospital Study Shows Link Between Vitamin D, Skin Cancer

Detroit, MI – A Henry Ford Hospital study has shown a link between Vitamin D levels and basal cell carcinoma, a finding that could lead researchers to better understand the development of the most common form of skin cancer.

In a small study, researchers at Henry Ford and Wayne State University found elevated levels of Vitamin D enzymes and proteins in cancerous tissue taken from 10 patients compared to normal skin tissue taken from them.

Previous studies have linked Vitamin D deficiency with certain cancers but this is believed to be the first time researchers looked at Vitamin D and basal cell carcinoma.

This finding may help us in future research to determine whether vitamin D plays a causative or reactive role in the development and progression of skin cancer, says Iltefat Hamzavi, M.D., senior staff physician in Henry Ford’s Department of Dermatology and the study’s lead author.

The study will be presented at the Photomedicine Society’s annual meeting in Miami, one day before the American Academy of Dermatology’s annual meeting.

Basal cell carcinoma, which affects about 1 million Americans a year, is the most common form of skin cancer. This cancer forms in the basal cells of the deepest layer of the skin. Mohs micrographic surgery is one of the most effective treatments for removing skin cancer.

The 10 patients enrolled in the study were diagnosed with basal cell carcinoma and ranged in age from 43 to 83. All had biopsies taken of cancerous tissue and surrounding normal skin tissue. Researchers found a 10-fold increase in Vitamin D enzyme levels and a two-fold increase in Vitamin D protein levels. The enzymes and proteins help regulate levels of Vitamin D in the skin. Two genes that play a role in DNA and tumor repair also had elevated levels of Vitamin D in cancerous tissue compared to normal tissue.

The study was funded by the American Society of Dermatologic Surgery, Wayne State University and Henry Ford Hospital.

Skin Cancer: the Common Treatable Cancer

With Wendy McFalda, DO

This year alone, approximately 1,000,000 people will be diagnosed with cancer – not breast cancer, lung cancer or prostate cancer – but non-melanoma skin cancer, according to the American Cancer Society.

Non-melanoma skin cancer will only prove fatal for approximately 2,000 people, but the number of people treated for this disease continues to rise while the average age of new patients diagnosed is getting younger.

“The younger kids have a double hit because they are outside a lot and using tanning booths,” says Dr. Wendy McFalda, a dermatologist in Clarkston. “We’re getting smart and putting sunscreen on kids when they go outside. Even some daycares are using sunscreen on kids when they play outside.”

However, despite this increased awareness most people still do not use sunscreen regularly, or they use it improperly. When using sunscreen, it is recommended that you apply the lotion approximately 30 minutes before going out into the sun. This allows for better absorption and increased protection. This first step is the easiest way to protect yourself from the sun’s harmful ultraviolet rays (UVA and UVB).

One way to make sure you are consistent with using your sunscreen is to make sure you have it readily available. Dr. McFalda recommends placing sunscreen in various areas where you frequent such as your office desk, car, boat and home.

The best time to protect yourself is now, says Dr. McFalda. Most skin damage occurs 20-30 years before the cancer itself may even present. This means people in their 40s, 50s and 60s may have already caused the skin damage that may lead to skin cancer.

The basic types of skin cancer are:

Basal Cell Skin Cancer – This slow-growing cancer is generally found in areas such as the face where sun exposure is most frequent. Rarely does it spread to other parts of the body.

Squamous Cell Skin Cancer – Although similar to basal cell in that it is found mostly in areas exposed to sun, it can also be found on other parts of the body that are not exposed to sunlight. Also, squamous cell skin cancer can spread to other organs and the lymph nodes.

Both basal cell and squamous cell skin cancers can be cured if found early and treated. The first sign of the cancer is usually an abnormality on the skin, or in a mole that begins to change shape, color or begins to bleed. When these changes occur, you should see your physician to take the next steps.

Although we think of skin cancer being a “summer” risk, it is important to protect yourself all year round, says Dr. McFalda. “Reflection of the rays off the snow can be just as damaging,” she says.

One way to catch skin cancer early is to have a full-body skin check. A visit to your dermatologist can help determine whether a new mole or change in skin is normal, or if it is the first sign of skin cancer.

“Men don’t get checked as often, but wives or girlfriends get them to come in because they see a spot change and it turns out to be melanoma. When this happens you should go back and kiss your wife because she may have just saved your life,” says Dr. McFalda.

If a tumor is spotted, a biopsy will be performed to determine if it is benign (non-cancerous) or malignant (cancerous). Most benign tumors can be removed and will not grow back, however, malignant tumors can invade other parts of the body, and may come back after they are removed.

If you are diagnosed with a malignant tumor, your physician will determine what Stage you are in. According to the National Cancer Institute (NCI), stages are generally determined by factors such as size of the tumor, the depth that it has penetrated into the layers of the skin, and whether it has spread to other organs or lymph nodes.

The NCI classifies the stages on a 0-4 scale.

Stage 0: The cancer only affects the top layer of skin.

Stage I: The growth is 2cm wide or smaller.

Stage II: The growth is larger than 2cm wide.

Stage III: The cancer has spread below the skin to the bone, cartilage, muscle or nearby lymph nodes. It has not spread to other places in the body.

Stage IV: The cancer has spread to other places in the body.

*Source: www.cancer.gov

Treatment for skin cancer may include surgery, chemotherapy, photodynamic therapy or radiation, depending on your stage of diagnosis.

As Dr. McFalda points out, being aware of your skin and its condition is important to identifying skin cancer. Do a “self-check” (page 11) of your skin periodically and have a dermatologist examine your skin for a baseline assessment. If you have family history, or are at high risk, you should have skin examinations more frequently.

The bottom line is to take care of your skin by protecting it from the sun’s dangerous rays, and you may not have to worry about future problems.

SIDEBAR: How To Do a Skin Self-Exam

Your doctor or nurse may suggest that you do a regular skin self-exam to check for skin cancer, including melanoma.

The best time to do this exam is after a shower or bath. You should check your skin in a room with plenty of light. You should use a full-length mirror and a hand-held mirror. It’s best to begin by learning where your birthmarks, moles, and other marks are and their usual look and feel.

Be on the lookout for any of the following skin changes:

• Small, smooth, shiny, pale or waxy lump
• Firm, red lump
• A sore or lump that bleeds or develops a crust or scab
• Flat red spot that is rough, dry or scaly and may become itchy or tender
• Red or brown patch that is rough and scaly

Check for anything new:

• New mole (that looks different from your other moles)

• New red or darker color flaky patch that may be a little raised

• New flesh-colored firm bump

• Change in the size, shape, color, or feel of a mole

• Sore that does not heal

Check yourself from head to toe. Don’t forget to check your back, scalp, genital area, and between your buttocks.

Look at your face, neck, ears, and scalp. You may want to use a comb or a blow dryer to move your hair so that you can see better. You also may want to have a relative or friend check through your hair. It may be hard to check your scalp by yourself.

Look at the front and back of your body in the mirror.

Then, raise your arms and look at your left and right sides.

Bend your elbows. Look carefully at your fingernails, palms, forearms (including the undersides), and upper arms.

Examine the back, front, and sides of your legs. Also look around your genital area and between your buttocks.

Sit and closely examine your feet, including your toenails, your soles, and the spaces between your toes.

*Source: National Cancer Institute online at www.cancer.gov

Dr. Wendy McFalda is board certified in Dermatolgy via the American Osteopathic Board of Dermatology. She received her Doctor of Osteopathic Medicine from Michigan State University College of Osteopathic Medicine. She is a member of the Michigan Osteopathic Dermatology Society, American Osteopathic College of Dermatology, the AMA and the American Osteopathic Association.

Taking Care of Your Skin Today to Avoid Problems in the Future

With Wendy McFalda, DO

Taking proper care of your skin now, as an adult, is as important as it was when you were a baby. In fact, the earlier you start taking steps to protect your precious skin, the better your results as you age.

But, many times, people make the mistake of not practicing good skin maintenance. The result can be dry skin, flaky skin, damaged skin due to sun exposure, or even skin cancer.

According to Dr. Wendy McFalda, a board certified dermatologist in Clarkston, the biggest skin care mistakes people make are using products that strip or irritate the skin, and not using sunscreen.

“Good foundational skin care is like going to the dentist, you wouldn’t go to the dentist and then never brush your teeth again,” says Dr. McFalda. “It’s important to maintain your skin by practicing good skin care.”

Skin care products are a big part of the cosmetic industry’s revenue. You can’t pick up a women’s magazine, watch the television or listen to the radio without someone promoting products to “improve the appearance of your skin.” However, just like a pair of shoes, results from a certain product are individualized.

“It is important to understand what type of skin you have,” says Dr. McFalda. “You don’t want your skin to feel overly dry when you finish washing your face. The shower soap is not appropriate all the time for some people. You have to find the right products for your skin.”

By understanding the skin problems you have, you can make better choices for your skin care, says Dr. McFalda. For example: Is your skin dry or oily? Do you have Rosacia (redness or broken blood vessels on the cheeks or nose); Is your skin red, dry and flaky (Seborrhea); Do you have brown patches on your face (Melasma)? Is acne a continuing problem?

Once you have the answers to some of these questions, you are more able to determine what type of product is most applicable for you. Depending on the condition, you may need a prescription medication versus an over-the-counter product. Either way, visiting a dermatologist can help you understand your approach.

It is well-documented that sun can cause damage to your skin. Dr. McFalda points out that you should not reserve using sunscreen only for the beach. “Many people make the mistake of not wearing it during the day, every day. Windows do not filter out all of the aging rays, nor do clouds and even rays reflecting off the snow can cause damage,” says Dr. McFalda.

To protect yourself on a daily basis, Dr. McFalda suggests placing sunscreen in various areas such as your car, your purse or desk at work. By protecting your skin from the sun, you can avoid many skin problems, including reducing your risk for melanoma.

Over-the-counter products can be effective, but you have to know what to look for as well as know what active ingredients work for/against your skin type.

“There are different active ingredients in skin care,” says Dr. McFalda. “There are things to take redness away from your face, pigment away if you have a lot of pigment, and treatments for dry or oily skin.” But, be a smart consumer, warns Dr. McFalda. “A lot of products advertised have little regulation, and all they have to do for approval is show that they alter the function of the skin, but may not actually fix the skin.”

She says because the products are mass marketed to a large number of people, they are not strong enough to deal with problems in an effective way because they are designed not to irritate the common skin.

Individualized Approach

Many people fail on skin care products because they do not properly evaluate their own skin, or misdiagnose their skin’s problems. One example is in the case of seborrheic dermatitis.

This red, dry, flaky condition that generally appears around the nose, eyebrows and eyelids is often mistaken for “dry skin.” Therefore, you may seek over-the-counter products to combat dry skin. However, this would not help this condition and you have spent unnecessary monies on a product that doesn’t work for you.

“People will go to Parisian and spend $200 on products, and don’t realize they can spend less going to a dermatologist to get the right diagnosis of what your skin type is and what will work the best for you,” says Dr. McFalda. “It is important to evaluate products to see what really works and what doesn’t. There is always something new coming out everyday and the new ‘hot’ products.”

Skin Care

Using an antioxidant in the morning, sunscreen during the day and a retinoid at night is an effective way to take care of your skin, says Dr. McFalda. The antioxidant can protect your skin from free radicals in the air that are looking to bind to your skin, thus causing damage. The retinoid will do repair work for you at night.

“Look at it this way. A peeled apple will turn brown during the day if you set it out. But if you put lemon juice on the apple, it won’t turn brown. Think of an antioxidant like the lemon juice, it protects your skin,” says Dr. McFalda.

“Your skin is an amazing organ, when you maximize its healing potential, it can heal itself. When you do things to prevent more damage, the energy your skin uses to protect itself, can now be used to heal instead.” Unless you notice changes in your skin that could be a sign of skin cancer or some other serious condition, most skin care practices can begin at home, says Dr. McFalda.

“Washing your face twice a day with an appropriate cleanser and understanding what type of skin you have is a good place to start. If you are not getting results from products you purchase, then see a dermatologist to help better understand your skin,” recommends Dr. McFalda. “Primarily we are trained to treat skin disease, but part of the treatment is preventing it.”

It is never too late to start protecting your skin. Damage you will SEE in the future is actually HAPPENING today. So, take the simple steps to protect yourself and your skin.

Dr. Wendy McFalda is board certified in Dermatolgy via the American Osteopathic Board of Dermatology. She received her Doctor of Osteopathic Medicine from Michigan State University College of Osteopathic Medicine. She is a member of the Michigan Osteopathic Dermatology Society, American Osteopathic College of Dermatology, the AMA and the American Osteopathic Association.

Ask the Doctor: March 2007

Question: I am a 57-year old male and have just started to get heartburn over the last few months. I was wondering, should I be concerned about anything more serious?

Answer: Heartburn is a very common problem and usually easily treated by diet, lifestyle changes and/or medications. However, there are some signs that should prompt you to see a doctor and be evaluated with an EGD (stomach scope). In your case, one of those factors is that you are over 55 years old.

Other “red flag” signs and symptoms are unexplained weight loss, persistent vomiting or vomiting blood, painful swallowing, and a feeling of being full after only a small amount of food. If you are using NSAIDs such as ibuprofen or naproxen, you should also tell your doctor. These signs and symptoms are concerning for ulcers, esophageal cancer, stomach cancer, or esophageal stricture, and you should be evaluated as soon as possible.

Question: Is there a way to “cure” athlete’s foot? I have recurring bouts and am not sure what to do to stop it.

Answer: Chronic athlete’s foot is difficult to treat but can be cured. However, if untreated, it can persist indefinitely. Over the counter creams are the standard treatment and will work, but you have to use them consistently for four weeks. If you don’t improve with the topical treatments, you can see your doctor for an oral medication. If you also have a fungal toenail infection, you should be treated with oral medications; topical will not work for you. In addition, treating your shoes with foot powder can help. You should also make sure that you get rid of any shoes you wear without socks (including your flip-flops you wear in the gym shower) because the athlete’s foot can live there.

Question: At what age should I have my skin examined for any signs of skin cancer? I am 32 but have not noticed any changes in my skin or any moles.

Answer: The current recommendations suggest that high risk people have yearly skin checks by a physician, with careful attention to the skin between checks, and evaluations sooner if moles change. However, the US Preventative Task Force guidelines do not suggest an age at which to start screening.

High risk patients include patients with fair skin, over the age of 65, a personal history of atypical moles or previous skin cancer diagnosis, or more than 50 moles on their body. Patients who do not fall into these groups should monitor their own skin for warning signs of skin cancer and seek evaluation for biopsy as soon as possible. The ABCDs of melanoma are: Asymmetry of the mole, Border irregularity, Color variability, or Diameter greater than 6mm (about the size of a pencil eraser).

Dr. Karen D. Lockwood is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, please email your question to: askthedoc@healthandleisureonline.com

*Advice found within this article is for information purposes only and should not replace the advice orrecommendations of your physician.