COVID UPDATE: Wastewater study technique finds virus variants sooner; many patients are using meds affected by Paxlovid:
With just a very small amount of raw sewage and a new analysis technique, researchers can determine the genetic mixture of SARS-CoV-2 variants in the community and detect new variants up to 14 days before they start showing up on patients' nasal swabs, according to a new report. Further sampling of wastewater across San Diego from September 2021 to February 2022 detected the presence of the Omicron variant more than 10 days before the first clinical detection in the city. With this new tool, you can take one wastewater sample and basically profile the whole city.
A sizable proportion of older patients may be taking medications that interact with Paxlovid. Blood thinners that should not be taken with Paxlovid were being used by 20% of people over age 65 and by 30% of people over age 80. Cholesterol-lowering statins that should not be taken with Paxlovid were being used by up to 18% of people older than 65, and more than 20% were using drugs like analgesics or heart medications that might require dose adjustments. Before prescribing Paxlovid, "the patient's full medical history” including herbals, over the counter and recreational drugs, must be known and co-treatment carefully managed by the treating physician, or by a specialist, to avoid detrimental effects.
With many people spending more time in the sun at this time of year it is important to pay attention to the moles, spots birthmarks and pigmented areas on our bodies.
What Is a Cancerous Mole? Symptoms, Causes, and Treatments, Explained by Dermatologists: Birthmark, beauty spot, mole-whatever you call them, these little growths tend to pop up throughout our lives. For the most part, these moles are harmless, serving only as markers to signal our uniqueness. But sometimes moles can be-or turn-cancerous, and potentially even deadly.
Technically speaking, a cancerous mole is known as a melanoma, or a type of skin cancer that develops in the skin's pigment producing cells called melanocytes. Although melanoma only accounts for about 1% of all skin cancers, it's the deadliest kind, outranking both basal and squamous cell skin cancers. According to the American Cancer Society (ACS), an estimated 106,110 cases of melanoma will be diagnosed this year, and 7,180 people are likely to die from this aggressive form of skin cancer.
As you may already know, the biggest contributor to melanoma-as with most types of skin cancer-is repeated, unprotected exposure to ultraviolet (UV) rays, not only from the sun but also artificial sources like tanning beds.
What is a cancerous mole? A mole-technically known as a nevus, or nevi for multiple moles-is a common growth that develops on your skin, either dating back to childhood, or later in life, according to the American Academy of Dermatology Association (AADA). These growths happen when your pigment cells, or melanocytes, grow in clusters creating an overgrowth on the skin, the National Cancer Institute (NCI) says. Some moles may appear flat or raised, dark or light, and if you have lighter skin you could have anywhere between 10 and 40 moles on your body.
It's important to remember that not all moles are or will turn cancerous. "When we talk about moles there are congenital moles-like birth marks-moles that are completely benign, and then there are [dysplastic] moles with some atypic, meaning under the microscope we see atypical or odd-looking cells," says Mary L. Stevenson, MD, a dermatologic surgeon based in New York City.
Congenital moles are usually small, have a round smooth surface, and are dome-shaped, according to the NCI. They're also usually pink or brown, with the color generally coordinating to your complexion tones-lighter moles on those with fair skin and hair color, and darker moles on those people with darker skin and hair. Dysplastic nevi, or atypical moles, may be larger than common moles, with different characteristics in shape, color, and texture, according to the NCI. Many atypical moles are flat instead of round, and have an irregular border.
Both of those moles have the potential to become cancerous-but the chances of that happening are very slim. Dysplastic nevi specifically have a slightly higher chance of becoming cancerous, since the they already contain some atypical cells. It's important to note that a cancerous mole can pop up on areas of the skin that were previously clear or free of moles.
A cancerous mole is known as a melanoma, or a malignant melanoma, states Debra Jaliman, MD, a board-certified dermatologist and assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai. In addition to developing from a common mole, an atypical mole, or just a clear spot of skin, melanoma can also show up in the eye, digestive system, or in other areas of the body, per the NCI. Melanoma is the deadliest type of skin cancer. That's because, as opposed to other common types of skin cancers, melanoma can invade nearby tissue and spread to other areas of the body (metastasize) to the the lungs, liver, bone, or brain, the NCI says.
What causes a mole to become cancerous? Not every mole will turn into a melanoma, and not every melanoma stems from a strange mole, says Dr. Jaliman. In fact, researchers don't know exactly what causes some moles to turn cancerous, while others stay benign, though there are a handful of risk factors that contribute.
Sunlight or artificial rays from tanning beds or other sources are one major risk factor. "UV [ultraviolet] light exposure is the single biggest risk factor for the development of cancerous spots,"says Joshua Zeichner, MD, associate director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. "The UV light causes free radical damage to the skin cells and leads to a transformation into an atypical, unregulated cell."
Having a large amount of moles-more than 50 common moles, or more than five atypical moles-can also up someone's risk of developing melanoma, per the NCI.
Other risk factors include: having fair skin, freckling, and light hair; a family or personal history of skin cancer or melanoma, and having a weakened immunes system, either from illness or medication. Being older and male are also risk factors for melanoma, the NCI says.
For the most part, both common and atypical moles should stay the same, regarding size, shape, and color-and it's when any mole, old or new, begins to change, that you should take notice.
There are a few different ways to examine moles to see if they're concerning. The first is called the ABCDE method, says Dr. Zeichner, who describes the acronym below:
A: Asymmetry, when one side does not look like the other side.
B: Border, when the border is jagged or punched out rather than smooth.
C: Color, when a mole has multiple colors to it, like brown, black, white, or blue.
D: Diameter, when a mole has a diameter greater than six millimeters (aka the size of a pencil eraser).
E: Evolution, when a mole changes in shape or appearance over time.
Another common symptom of cancerous moles is discomfort like itchiness or pain, according to the AADA.
Seeing brand-new moles pop up on your skin-also known as acquired moles-may also be something to watch out for. So, if you have a new mole that looks concerning, you should get it checked out.
How are cancerous moles treated? If you or your doctor discovers a concerning mole, it will normally be placed into one of three categories: mild, moderate, and severely atypical (meaning you should get it checked immediately), says Dr. Stevenson. "Generally speaking we remove atypical moles that are moderate or severe to ensure [the] entire lesion is out and there was not a sampling error with the biopsy that only took a portion of the specimens," she says.
If a skin biopsy determines melanoma, swift action is necessary, since the type of skin cancer can spread very quickly to other tissues and organs, per the AADA.
According to the ACS, surgery is the main treatment option for most melanomas, and it is usually able to cure early stages of the disease. The types of surgery include: wide excision, Mohs surgery, lymph node dissection, metastatic melanoma surgery, and extremely rare cases, amputation.
Wide excisions are used when thin melanoma (superficial layers of skin) is diagnosed by a skin biopsy, and involves removing the tumor and a small area of healthy skin around the area to ensure removal of all cancerous cells. Mohs surgery involves a specialist removing thin layers of skin one section at a time until no cancer cells are detected, and leaves less of a scar. In rare situations, amputation may be considered if the melanoma is deep in a digit like a finger or toe. A lymph node dissection removes the lymph nodes around the melanoma tumor where it would most likely spread first. Finally, if the melanoma has spread, then metastatic melanoma surgery could be an option, but it would be to control the cancer, not cure it.
Once the melanoma becomes more aggressive, other types of therapy may be considered, like immunotherapy, targeted therapy, chemotherapy, and radiation therapy, according to the ACS.
How can you prevent cancerous moles? Prevention is key when it comes to protecting yourself against melanoma and other types of skin cancer. And while some risk factors can't be controlled-like your age, sex, or family history-there are some things you can do to help lower your overall risk.
First and foremost, you want to limit your exposure to UV rays as much as possible-that means practicing sun safety while you're outside and not exposing yourself unnecessarily (like in a tanning bed). When you do go outside, protect your skin through sunscreen, as well as protective clothing, a hat, and sunglasses.
Keeping track of how your skin looks is important too. "If you notice a new or changing spot, make sure to get it checked by your dermatologist ASAP," says Dr. Zeichner. "When detected early the atypical moles can be removed completely without any risk of progression into skin cancer." Keeping an eye on your skin in general is a good idea too-not just if you detect changes. Dr. Stevenson recommends everyone get checked twice a year by a dermatologist.
Until Next Time: Stay Safe, Stay Healthy and be careful out there
James A Vito, D.M.D