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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 Southern Skin 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 Page 1 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) Southern Skin 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). Page 2 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 Southern Skin 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%. Page 3 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] Southern Skin 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. Page 4