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University of Alabama at Birmingham
Southern Skin
VOLUME 5, ISSUE 1
SPRING, 2 0 1 0
The Clinical Newsletter of the
UAB Department of Dermatology
Congratulations to our
Dermatologists!
414 Eye Foundation Hospital
1720 University Boulevard
Birmingham, AL 35294-0009
205-996-7546 (SKIN) — TKC
205-939-9141 — Pediatrics
www.uab.edu/derm
Clinical Faculty
Craig A. Elmets, M.D.
Chair
Eczema and Psoriasis,
Phototherapy, Patch Testing, and
Photosensitivity Diseases
Boni E. Elewski, M.D.
Vice Chair
Fungal Infections, General
Dermatology, Clinical Trials
The Department of Dermatology is pleased to note that
faculty members Drs. Boni
Elewski, Craig Elmets, and
Patricia Mercado (as pictured
from left to right) have been
named as “2009 Best Dermatologists in America”.
The
“Best Doctors” organization is
an employer- and insurance
company-sponsored program
designed to facilitate informed
consumer health care
choices.
Physicians are selected for
this designation on the basis
of a peer-to-peer survey of
other practitioners. Physicians
do not pay to be listed as a
“best doctor”, and the physiInside this issue:
Best Dermatologists in Birmingham
1
Pigmented Lesions Clinic
2
Merkel Cell Carcinoma
3
Merkel Cell Carcinoma
4
Ongoing Clinical Trials
5
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icians surveyed receive no incentive to participate. The survey includes questions such
as “If you or a loved one
needed a doctor in your specialty, to whom would you refer them?” Further information
about the details of the survey
are
available
at
www.bestdoctors.com.
The selection of three physicians from the UAB Department of Dermatology is especially noteworthy, as less than
five percent of all medical specialists in the United States
are listed in the Best Doctors
Guide. All three of the honored
physicians see patients at The
Kirklin Clinic. Appointments
with them or with any of the
other highly qualified dermatologists listed on the right
panel of this page can be
made by calling 996-SKIN
(7546).
!
Jennifer Cafardi, M.D.
General Dermatology, Skin Infections
Vladya Groysman, M.D.
General and Womens’s Dermatology
Conway Huang, M.D.
Skin Cancer, Mohs Surgery
Lauren Hughey, M.D.
General Dermatology,
Cutaneous T- cell Lymphoma,
Consultative Dermatology
Rebecca Kissel, M.D.
General Dermatology
Patricia Mercado, M.D.
Hair Disorders, General Dermatology
Marian Northington, M.D.
Cosmetic Dermatology,
General Dermatology
Naveed Sami, M.D.
Blistering Diseases,
General Dermatology
Amy Theos, M.D.
Pediatric Dermatology,
Genetic Skin Diseases
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UAB Department of Dermatology
Pigmented Lesions Clinic
Melanoma Prevention
Wendy Cantrell, Certified Registered Nurse
Practitioner, is pleased to report that the Multidisciplinary Pigmented Lesions Clinic, which has
been held weekly for over two years, has yet to
diagnose a melanoma. Ms. Cantrell believes
that this fact demonstrates the effectiveness of
this specialized clinic for preventing melanoma
in patients at high risk for the disease who require close observation. The necessary observation involves both total body photography
and careful examination by a dermatologist
with a special instrument called a dermatoscope. The combination of these approaches
has been shown by several studies to be an
effective means of identifying worrisome lesions at an early stage before they develop into
melanoma and of reducing the number of biopsies required.
The first steps in the prevention of all skin
cancers include skin self examinations and detailed physical examination by a health care
provider. For patients at high risk of melanoma,
however, these steps are not enough. According to Craig Elmets, M.D., Dermatology Chair
and Clinic Director, patients appropriate for the
Pigmented Lesions Clinic due to elevated risk
include those with at least one of the following:
a personal history of melanoma, a personal
Patient followed at the Clinic for multiple
abnormal moles (dysplastic nevi)
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history of abnormal moles known as dysplastic nevi, or more than 50 moles on the body.
Mole suspicious for melanoma due to
an irregular border.
Patients seen for an initial appointment receive a thorough evaluation by a faculty dermatologist and undergo digital photographic mapping of their moles. This consists of high resolution digital photography of all body regions. Images are stored on a secure database. The initial visit is often not covered by insurance. Follow-up every three to six months allows comparison of the stored images with the most recent examination. Patients are encouraged to
continue with self examination and are given a
copy of the mole mapping evaluation on a CD
for this purpose.
The Mulitdisciplinary Pigmented Lesion Clinic
is staffed by Dr. Elmets, Dr. Conway Huang, an
expert Procedural Dermatologist, Ms. Katie
Tuck, CRNP, and Ms. Cantrell from the Department of Dermatology. Surgical and Medical Oncologists are available if a melanoma is diagnosed. Genetic counseling is also available
when appropriate.
Appointments are available on Thursday
mornings and can be made by calling 996-SKIN
(7546).
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UAB Department of Dermatology
Merkel’s Carcinoma—Ask Dr. Elmets
Merkel cell carcinoma on the right ear.
What is Merkel cell carcinoma?
Merkel cell carcinoma is a rare type of skin
cancer that forms on or just under the skin and
in hair follicles. Approximately 1200 cases are
diagnosed in the United States each year.
Merkel cells are known as neuroendocrine cells
because they release hormones. They are located very close to the nerve endings responsible for the sense of touch. Although very rare,
the incidence of Merkel cell carcinoma is increasing. Recent evidence indicates that
Merkel Cell Carcinoma is caused by the
Polyoma virus.
What are the symptoms?
Merkel cell carcinoma usually manifests as a
firm, often dome-shaped, non-movable, quickly
growing, painless nodule which may be fleshcolored, red or blue. Merkel cell tumors are
associated with sun exposure, with fifty percent
occurring on the head and neck and forty percent on the arms and legs. The disease is most
common in people over 60 years of age.
Are there any risk factors?
Risk factors for Merkel cell carcinoma include a history of sun exposure or exposure to
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the immune system (e.g. HIV, organ transplant), previous history of basal cell or
squamous cell carcinoma, and older age.
The disease is twice as common in men as
in women. Some Merkel cell carcinomas
have been associated with a newly discovered member of the family of polyoma viruses. These viruses are known to cause
cancers in both animals and humans. MCV,
the polyoma virus associated with Merkel
cell carcinomas, may be a common cause
of respiratory infections. However, in those
in whom MCV is linked to Merkel cell carcinoma, the virus has undergone mutations
that may be promote the cancer.
How is Merkel cell carcinoma diagnosed
and treated?
Merkel cell carcinoma can only be diagnosed by surgical biopsy. The pathologist
uses immunohistochemical techniques to
distinguish between Merkel cell carcinoma
and other types of skin cancer. Surgery, either traditional surgery or Mohs micrographic surgery, is the first line of treatment
for the disease. A border of healthy tissue
and nearby lymph nodes may also be removed. The surgeon may perform a biopsy
of the first lymph node where the cancer is
likely to spread (known as the sentinel
lymph node). Patients with Merkel cell carcinoma may also receive radiation therapy to
the area of the tumor and possibly be
treated with chemotherapy.
What is the prognosis?
The prognosis for patients with Merkel
cell carcinoma is much better when the disease is detected at an early stage. Small
tumors with no spread to the lymph nodes
have a five year survival rate of over 90%.
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Dermatology Department
Residents and Friends
Department of Dermatology
Ongoing Clinical Trials
Are you interested in supporting
the UAB Department of Dermatology
Residents and Friends Fund?
Are you interested in free
treatment through a clinical study?
In making a gift to the Department of Dermatology, you will do so much more than writing
a check:
Do you suffer from any of
the following conditions?
Abnormal Moles
Cutaneous T-cell Lymphoma (CTCL)
- You will foster discovery through basic and
clinical research.
- You will provide quality care and support for
our patients.
- And you will supply physicians with the tools
they need to further their work.
Gifts to UAB are tax-deductible and may be
made with cash, appreciated securities, real
property, or through your estate plan. Pledges
may be made over a period of up to five
years.
For more information on supporting the Department of Dermatology at UAB – supporting
great science, great care and great outcomes
— call or email today:
Rebecca Gordon
Director of Development
School of Medicine at UAB
Faculty Office Towers 1236
510 20th Street South
Birmingham, AL 35294-3412
(205) 996-6839
Fax: (205) 975-7305
[email protected]
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Epidermolysis Bullosa
Hand Dermatitis (eczema on the hand)
Onychomycosis (toenail fungus)
Psoriasis
Psoriatic Arthritis
Sarcoid
Skin Tags
Tinea Versicolor
We also have two long-term follow-up
studies including:
ATLAS (for patients already
on Amevive)
PSOLAR (for patients on
biologic therapies for psoriasis)
Contact the UAB Dermatology clinical
research office at (205) 502-9960 / 9962
for more information.
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