Robert J Weiss, MD PC
Sunday, April 27, 2014
Is that groin rash cancer ??
Is that groin rash cancer ??
A few years ago one of my male patients presented with a groin rash of
several months duration which was unresponsive to various topical antifungals and
topical corticosteroids prescribed by his health care practitioner.
The rash was red and scaly encompassing both his groin and extending
to his scrotal areas. There was associated itching and burning at times.
The most important clue here was the fact that the rash had been
chronically unresponsive to the above measures.
And,I immediately suspected a condition called extramammary Paget's
disease (EMPD) which fortunately is a rare cancerous condition of apocrine-
gland bearing sites.
Two types of EMPD have been described: the primary type thought to arise
from a stem cell within genital skin and not associated with an underlying internal
malignancy involving the rectum and/or other internal body areas. However, it is
still a carcinoma of the skin and needs to be treated.
Secondary EMPD is the more dangerous type since it is associated with
an underlying adnexal adenocarcinoma or an underlying visceral (internal)
cancer and is the same as mammary Paget's disease of the nipple.
I referred my patient to a general surgeon for a deep excisional skin
biopsy which confirmed my clinical suspicions. The presence of a cellular
protein called cytokeratin 20 helps to differentiate between the primary and
secondary types of EMPD.
In addition, the presence of a gene called HER-2 in the biopsy specimen
may indicate a high risk for spread to lymph nodes and the need to follow this
patient very diligently.
EMPD most frequently involves the vulva in women,the perianal area,perineum,
scrotum,penis, and armpits. Treatment includes wide surgical excision,radiation
therapy and several topical agents.
Sunday, April 6, 2014
Brief Overview of Lasers in Dermatology
Lasers basically emit bright beams of light energy that is converted
to heat energy in the skin. And,it is this heat energy that performs the many
dermatological functions of lasers.
These functions include treating spider veins,dilated blood vessels,
the redness of rosacea,scars,stretch marks, liver spots,freckles,tattoos, and benign dark
spots on the skin such as age spots.
In addition,lasers help to remove unwanted body hair and stimulate
collagen production to eliminate fine lines,skin creases,and wrinkles.
In my opinion,the birth of fractional resurfacing lasers is one
of the most exciting developments in laser therapy since these lasers literally
treat only a "fraction" of the skin at a time and, therefore, dramatically reduce
the incidence of side effects such as scarring,pigment changes, and infection.
Future possible therapeutic uses for lasers include enhancing
the percutaneous delivery of drugs and also healing chronic wounds and ulcers.
Tuesday, April 1, 2014
Psoriasis: more than a skin disease ?
A recent study implicates Psoriasis with a 70 % increased likelihood of
developing non-alcoholic fatty liver disease (NAFLD) which is the most
common form of chronic liver disease in Western countries.
In addition,Psoriasis patients with NAFLD were also 60 %
more likely to have the severe form of NAFLD.
The most distinguishing feature of NAFLD is the accumulation of
triglycerides(a type of lipid or fat) in the liver cells called hepatocytes.
Risk factors for NAFLD besides Psoriasis include diabetes,hypertension,
obesity,a sedentary lifestyle,smoking and a poor diet.
Besides advising my patients with Psoriasis about the increased
cardiovascular risks (see my earlier post on "the heartbreak of Psoriasis"),
I shall now inform them of the non-alcoholic fatty liver disease risk and
again recommend regular checkups with their healthcare practitioner.
Sunday, March 30, 2014
Disclaimer
Disclaimer:
Please note that the information on dermatologyandmedical.blogspot.com
is intended for educational purposes only and is not intended to treat,cure, or diagnose
your condition,nor is the information on this site to be used in lieu of consulting
your physician or other qualified health care provider.
These popular meds can cause sunburn:
The following list of medications is certainly not all-inclusive since
many different classes of prescription and over-the-counter drugs can
make the skin more sensitive to ultraviolet rays.
Some of the more well-known medications are:
Antibiotics: tetracycline,doxycycline hyclate(not the smaller dose
brand known as Oracea), and sulfa-containing drugs such as trimethoprim/
sulfamethoxazole
Arthritis drugs: Ibuprofen, naproxen
Blood pressure/"water pill" drugs: hydrochlorthiazide(more a blood pressure
drug than a water pill),furosemide(more a water pill than a blood pressure drug),
These two both contain sulfa (a photosensitized)
A recent study showed that the calcium channel blocker nifedipine
and the ACE inhibitor lisinopril increased sun sensitivity and made users
more likely to develop lip cancer.
Diabetes drugs: glipizide (contains sulfa),glyburide(contains sulfa),and
chlorpropamide which also contains sulfa
The bottom line with all of these is that the benefit of these drugs
certainly outweighs the possible sun-sensitivity side effect that can
be offset with the proper use of sunscreens and sun-exposure.
And they should be discontinued only with the consent of the
health care practitioner prescribing them.
Tuesday, March 25, 2014
Merkel Cell Carcinoma(MCC)-a blood test to predict spread
In the 50 % of patients who produce antibodies to the MCC polyomavirus
oncoprotein at diagnosis,there is now a blood test to measure these antibodies upon
follow up visits .
Since about 40 % of MCC's recur ,this blood test can be an early way
to detect Metastasis (spreading) in otherwise asypmtomatic patients who have
these antibodies-long before these "mets" show up on diagnostic testing.
Thursday, March 20, 2014
Skin Cancer:Not just the Sun
Most of us are aware that excessive ultraviolet radiation from the
sun can cause skin cancer.
However,there are other potential causes of skin cancer and these
include:
1) X-ray irradiation
2)non-healing and chronic skin sores and ulcerations. I always
suspect a type of skin cancer called squamous cell carcinoma in
my patients with these problems.
3)vaccination marks and scar tissue
4)arsenic in well water (more likely near sod and turf farms))
5)both internal cancer and the radiation and/or chemotherapy
used for treatment: both the cancer and the treatment modalities can
suppress the immune system making one more likely to have skin
cancer
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