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Statement by The British Association of Dermatologists on Cosmetic Injections (Intradermal Fillers)

The recent PIP breast implant furore has resulted in questions not just about the regulation of cosmetic surgical procedures but also about regulation of injectable intradermal fillers. Injection of intradermal fillers is one of the most popular cosmetic procedures in the UK with hundreds of thousands of procedures performed annually, compared to less than 10,000 breast augmentation procedures. A recent article in the Times1 states that there are160 injectable fillers certified for sale in the UK and that they can be purchased and administered by anyone, including those with no medical training. The BAD is concerned about both the safety of some of these products and also the absence of direct regulation of who is allowed to inject them. Significant changes are required in order to safeguard patients and the public.

Intradermal fillers are classified in the UK as a medical device; the requirements to obtain a CE mark to allow certification for sale are minimal. This puts the public at unnecessary risk. Intradermal fillers are not “inert” and have been shown to cause physiologic changes in the deeper layers of the skin. Debilitating long-term reactions to various products are well documented in the medical literature. In order to improve patient safety, adequate safety and efficacy data should be a requirement for any intradermal filler prior to entry into the market.

Injection of intradermal fillers is a medical procedure, albeit for a cosmetic indication. The trivialisation of these medical procedures by absence of direct regulation of who is allowed to administer them is hazardous. Facial anatomy is complex and includes elaborate networks of nerves, blood vessels and other important structures; any injection using a hypodermic needle can potentially cause serious or irreversible complications. Those injecting should have the breadth of medical knowledge to not only safely administer the intradermal filler, but also to understand the potential complications with the ability to treat them appropriately should they arise. Absence of this specialist knowledge may unduly burden the NHS.

As a consequence the BAD would call on the government (via the offices of the Department of Health and the MHRA) to:

1) Reclassify all injectable intradermal fillers as drugs/medicines OR significantly increase the requirement for evidence-based safety and efficacy data prior to their approval as medical devices.

2) Ensure that intradermal fillers may only be prescribed by medical practitioners (such as dermatologists and plastic surgeons) who have not only been trained in their indication and administration but have the breadth of knowledge to understand the evidence-base for their use. In addition, prescribers should have the ability to recognise and understand the pathomechanisms of any complications which might arise in order to treat them appropriately. This is particularly important in the light of potential financial implications to the NHS if private practitioners are unable to recognise and treat complications which arise in their own patients.

3) Ensure that patients or “customers” seeking these procedures receive appropriate counselling regarding the risks and benefits of the procedure by a practitioner who has the specialist professional knowledge to understand the potential benefits, complications and treatments thereof, which are based on scientific evidence.

4) Recognise that injectable treatments are a cosmetic application of a medical procedure. As such, a core foundation of medical knowledge is required to administer them appropriately and safely.

5) Recognise that as medical procedures, excessive advertising and financial incentivisation (both for the patient and the practitioner) is inappropriate.

6) Produce guidelines reflecting these changes which specify exactly: who can prescribe intradermal fillers; who can administer intradermal filler procedures and; what levels of appropriate professional training are required.

7) To make clear both to the cosmetic industry and the public what these changes mean and why they are important to patient safety.

This statement has been prepared by the British Association of Dermatologists in conjunction with its affiliated specialist group, the British Cosmetic Dermatology Group, and is endorsed by the British Academy of Cosmetic Practice.

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Prolonged breastfeeding does not protect against eczema, global study shows

The largest worldwide study on the association between breastfeeding, time of weaning and eczema in children has concluded that there is no clear evidence that exclusive breastfeeding for four months or longer protects against childhood eczema, according to research due to be published in the British Journal of Dermatology 24th August 2011.

The researchers, based at King’s College London, The University of Nottingham and the University of Ulm, Germany, looked at data from 51,119 children aged eight to 12, from 21 countries, as part of Phase Two of The International Study of Asthma and Allergies in Childhood (ISAAC)*, the largest epidemiological research project ever undertaken. Their findings have prompted them to call for a review of the current UK breastfeeding guidelines with regard to eczema.

Information on eczema, breastfeeding and time of weaning was gathered by parental questionnaire. Children also underwent a skin examination for eczema and skin prick testing to environmental allergens, including house dust mite.

Earlier studies have suggested a protective effect of breastfeeding on childhood eczema, and the UK Department of Health currently recommends exclusive breastfeeding for six months to prevent eczema, in line with the World Health Organisation. However, a review of the more recent literature found no evidence for a protective effect of exclusive breastfeeding for three months or longer on eczema development1, in keeping with the findings from this study.

The authors also point out that there is mounting evidence to suggest that the early introduction of potentially allergenic food proteins, such as peanut, could increase tolerance to these foods, rather than causing allergy, although this remains to be confirmed in intervention studies.2

This worldwide study therefore sought to investigate to what extent exclusive breastfeeding protects against childhood eczema. It concluded that children who were exclusively breastfed for four months or longer were as likely to develop eczema as children who were weaned earlier.

Dr Carsten Flohr, one of the researchers based at King’s College London, said: “Although there was a small protective effect of breastfeeding per se on severe eczema in affluent countries, we found no evidence that exclusive breastfeeding for four months or longer protects against eczema in either developed or developing nations. We feel that the UK breastfeeding guidelines with regard to eczema should therefore be reviewed. Further studies are now required to explore how and when solids should be introduced alongside breastfeeding to aid protection against eczema and other allergic diseases.”

Dr Flohr is keen to emphasise that other benefits of breastfeeding on infant health, unrelated to eczema, are not being disputed. He explained: “It is widely accepted that breast milk is the most important and appropriate nutrition in early life. Especially in the context of developing countries it is also important to keep in mind that exclusive breastfeeding reduces the risk of gastrointestinal infections compared to mixed or bottle feeding. Our study does not change this notion.”

Nina Goad of the British Association of Dermatologists said: “The size of this study means that its findings are very significant, although the authors recognise that further studies are required. Following these further studies we may need to review the UK’s advice on how long mothers should breastfeed exclusively for, and at what age we should be weaning our infants, in relation to eczema prevention.

“This study isn’t about the benefits of infant formula milk versus breast milk, nor is it questioning other benefits of breast feeding, but it is about whether breastfeeding exclusively for prolonged periods and weaning after six months, as opposed to after four months, has any impact on eczema risk.”

Professor Hywel Williams from The University of Nottingham added: “There is no doubt that breast is best in terms of prevention of infections and parental bonding, but mothers who cannot breastfeed should not feel guilty if their child develops eczema. The evidence that prolonged and exclusive breastfeeding protects against eczema is not convincing.”

Background information

The definitive study design to explore how and when solid foods should be introduced alongside breastfeeding to optimally protect against allergic disease is a randomised controlled trial. Such a trial is currently being conducted at the Children’s Allergies Department at St. Thomas’ Hospital (‘Enquiring About Tolerance’ (EAT) Study; www.eatstudy.co.uk).

The Scientific Advisory Committee on Nutrition (SACN) is currently undertaking a review of the scientific evidence underpinning the United Kingdom infant and young child feeding policy, stating that since the Committee on Medical Aspects of Food Policy (COMA) published its report ‘Weaning and the weaning diet’ in 1994, there has not been a thorough risk assessment of such evidence in the UK. (www.sacn.gov.uk)

*ISAAC, The International Study of Asthma and Allergies in Childhood, is a unique worldwide epidemiological research programme established in 1991 to investigate asthma, rhinitis and eczema in children due to considerable concern that these conditions were increasing in western and developing countries. ISAAC has become the largest worldwide collaborative research project ever undertaken, involving more than 100 countries and nearly two million children. Its main aim is to develop environmental measures and disease monitoring in order to form the basis for future interventions to reduce the burden of allergic diseases, especially in children in developing countries.

References

1 •Yang YW, Tsai CL, Lu CY. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. Br J Dermatol 2009;161:373-83. • Fewtrell M, Wilson DC, Booth I, Lucas A. Six months of exclusive breastfeeding: how good is the evidence? Brit Med J 2011; 342: 209-12. • Department of Health. Weaning and the Weaning Diet. Report of the Working Group on the Weaning Diet of the Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects No 45. 1994 HMSO, London. • Burr ML, Butland BK, King S, Vaughan-Williams E. Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child 1989;64:1452-6. 2 • Burks AW, Laubach S, Jones SM. Oral tolerance, food allergy, and immunotherapy: implications for future treatment. J Allergy Clin Immunol 2008;121:1344-50. • Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008;122:984-91.

Notes to editors:

1. The information in this press release is embargoed until 00:01 on 24th August 2011. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists

2. For more information please contact: Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6355, Email: deborah@bad.org.uk, Website: www.bad.org.uk

3. Articles in the BJD can be viewed online: www.brjdermatol.org British Journal of Dermatology: Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema: Lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two; C. Flohr1, G. Nagel2, G. Weinmayr2, A. Kleiner2, D.P. Strachan3, Hywel C. Williams4, and the ISAAC Phase Two Study Group. 1Department of Paediatric Allergy & Dermatology, St John’s Institute of Dermatology, St Thomas’ Hospital and King’s College London, UK; 2 Institute of Epidemiology, University of Ulm, Germany; 3Division of Community Health Sciences, St. George’s, University of London, United Kingdom; 4 Centre for Evidence Based Dermatology, University of Nottingham, UK.

• The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

• Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

• The University of Nottingham, described by The Sunday Times University Guide 2011 as ‘the embodiment of the modern international university’, has award-winning campuses in the United Kingdom, China and Malaysia. It is ranked in the UK's Top 10 and the World's Top 75 universities by the Shanghai Jiao Tong (SJTU) and the QS World University Rankings.

• King's College London is one of the top 25 universities in the world (2010 QS international world rankings), The Sunday Times 'University of the Year 2010/11' and the fourth oldest in England. King's has an outstanding reputation for providing world-class teaching and cutting-edge research. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts. 

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16 to 30s worst at skin cancer prevention, new research reveals

16 to 30-year-olds are the worst at protecting their skin in the sun, despite melanoma being the second most common cancer in this age group, according to a new study out this week.

The research, due to be released at the British Association of Dermatologists’ Annual Conference in London this week (July 4th to 7th), explored the sun safety knowledge and behaviour of 1,000 adults, interviewed over a two-month period. The respondents were split into age categories of 16 to 30, 31 to 45, 46 to 60 and over 60 years.

An understanding of ways to avoid skin cancer in the 16 to 30-year-old group was rated worse than all other age groups. Those aged 16 to 30 years were also significantly more likely to get sunburned and were less likely to avoid midday sun exposure or to cover up in the sun compared with older age groups.

Those aged 16 to 30 reported the highest levels of sun exposure, with 54 percent heading out into the sun daily, compared to 44, 48 and 50 percent of older age groups, respectively.

17 percent admitted to never avoiding the sun during its peak hours (11am to 3pm) compared to nine percent of 31 to 45-year-olds, six percent of 46 to 60s and seven percent of over 60s.

At least three times as many 16 to 30s allow their skin to burn in the sun at least once a year than the older age groups, with almost one in five (19 percent) admitting to regular (more than annual) burning, compared to six percent each of 31 to 45s and 46 to 60s, and just three percent of over 60s. Only one in five of the youngest age group (19 percent) never let their skin burn.

A shocking 23 percent of 16 to 30-year-olds admit they never protect their skin in the sun with clothing and a hat. This compares with eight, 11 and six percent of the older age groups, respectively.

Alarmingly, young people with either a personal history of skin cancer, or a member of the family who has suffered from the disease, were no less likely to expose their skin to the sun or to sunburn than those without any personal or family history of skin cancer.

Those with such a history were more likely to wear sunscreen but not to cover up in the sun. Furthermore they did not rate their understanding of the ways to avoid skin cancer as significantly better than those without such a history, nor were they more likely to appreciate the relationship between skin cancer and sun exposure.

Skin cancer is the UK’s most common cancer, with over 100,000 new cases diagnosed every year, and it continues to rise faster than any other cancer type. Rates of melanoma, the most dangerous type of skin cancer, have tripled in 15 to 34-year-olds in the last 30 years.

Nina Goad of the British Association of Dermatologists said: “With so much education – both in schools and in publicity campaigns – aimed at young people, it is a real worry that this age group are still either ignorant to or choosing to ignore sun safety messages. It seems likely that a number of factors are at play here, including a lack of understanding of how to stay safe in the sun (as suggested by the use of sunscreen but ignorance of clothing and shade as protective measures), but also the pressure and desire amongst young people to looked bronzed. Also, as we get older, we start to take into account the ageing effects of the sun more, and often protect our skin for this reason, and this may not be such a deterrent in young people. We definitely need to look more at what will help encourage young people to adhere to anti-sunburn advice.”

Dr Antonia Lloyd-Lavery, from Oxford Radcliffe Hospitals NHS Trust Dermatology Department and one of the researchers, said: “Our results indicate that younger patients are less likely to practise safe sun exposure. Furthermore, our results suggest that those with a personal or family history of skin cancer may not have received critical education on safe sun exposure from the medical profession. UK based health awareness programmes should therefore particularly target younger age groups. In addition, healthcare professionals must ensure that opportunities are taken to reinforce the importance of safe sun exposure among patients.”

The aim of this study was to investigate current knowledge, awareness and attitudes towards the prevention of skin cancer in patients attending their general practice in the UK. Patients aged 16 years and over presenting to one of three general practices (two urban, one rural) in the UK between 1 June and 31 July 2010 were invited to complete a paper-based questionnaire collecting data on participant demographics, skin cancer risk, their understanding of the role of excess sun exposure in skin cancer development and sun-protection behaviour.

A total of 1000 patients responded comprising 327 men and 673 women.

-Ends-

Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference. The conference will be held at ICC ExCel London, 4th to 7th July 2011, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, British Association of Dermatologists, Communications Manager, Phone: 0207 391 6355 or 07825 567717 (mobile during conference week only), Email: nina@bad.org.uk, Website: www.bad.org.uk

Study details: “Skin cancer awareness and sun-exposure behaviour in the U.K.”; D. Butler, A. Lloyd-Lavery, C. Archer* and R.J. Turner; Oxford Radcliffe Hospitals NHS Trust, Oxford, U.K. and *Royal Free Hampstead NHS Trust, London, U.K.

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

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Minister and celebrites back campaign to raise awareness of skin cancer amongst well-being, hair and beauty professionals

Ministers and celebrities are backing a campaign launched today by the Melanoma Taskforce and British Association of Dermatologists (BAD) to help well-being, hair and beauty professionals spot the signs of skin cancer in their clients.

Skin cancer kills more than 2,500 people in the UK every year and its most deadly form, malignant melanoma, is now the second most common cancer among young people in the UK. In an effort to improve awareness and early detection of the disease, the Taskforce and BAD have produced ‘Mole and Skin Check Guidelines’ to educate hairdressers, masseurs, therapists and other well-being professionals to spot the signs of skin cancer. The campaign has the support of a number of high-profile celebrities and industry leaders including actress and presenter Amanda Holden, Hollyoaks star Gemma Merna, TV & radio presenter Sarah Cawood and celebrity make-up artists Ruby Hammer and Millie Kendall (Ruby and Millie).

The guidelines will be officially launched in Parliament on Tuesday 21st June with the backing of Parliamentary Under-Secretary of State for Public Health, Anne Milton MP, who will emphasise the crucial role that professionals within these industries can play in facilitating the early detection of skin cancer.

It is vital that skin cancers are detected and treated early as swift diagnosis can help save lives. While professionals in the well-being, hair and beauty industries are not expected to diagnose skin cancers, they are uniquely placed to be able to notice changes in moles or suspicious lesions. Endorsed by nine leading industry bodies, the guidelines will provide clear and simple information on how to spot the signs of skin cancer, and how professionals can encourage their clients to seek medical advice.

The guidelines were developed as a result of recommendations made to Government by the Melanoma Taskforce in its ‘2015 Skin Cancer Visions’ report. They are also supported by research conducted by Nottingham City Hospital NHS Trust, in association with the patient group, Skcin. This research found that over 80% of hairdressers and around 95% of beauty therapists would like to know more about recognising the signs of skin cancer.

Siân James MP, Chair of the Melanoma Taskforce, said:
“These guidelines represent a major step forward in raising awareness of the importance of early detection of skin cancer. It is something for which we have consistently campaigned. I am also pleased that we have been able to draw support from a wide range of celebrities. It makes a big difference if young people can relate to role models about being careful with their skin.”

Professor Chris Bunker, President-elect of the British Association of Dermatologists, said:
We hold a number of mole check roadshows and worryingly, 85 percent of people attending these have a mole that was of particular concern, yet two-thirds of them have not seen a doctor about the mole before. It seems that changes to our skin are not always something we feel deserves immediate attention. This demonstrates the need to take our messages out to a wider audience, and to engage the help of hair, beauty and well-being professionals, who are often well placed to notice something untoward on a person’s skin.”

Amanda Holden, actress, television presenter and safe sun education campaigner, has also expressed her support for the campaign:
“I spend a lot of time in hair and make-up, and if I had an unusual looking mole, I would want my hairdresser or make-up artist to know what to spot. I believe it is vital that we do everything we can to ensure that people recognise the signs of skin cancer. Well-being, hair and beauty professionals up and down the country can play their part by looking out for possible skin cancers and encouraging people to visit their doctors.”

Alongside the launch, the BAD will be running a Mole Check Clinic in Parliament to raise awareness of the condition amongst MPs and Peers after a recent ComRes survey, conducted for the Melanoma Taskforce, indicated that MPs say they are more knowledgeable about breast cancer, oral cancer and prostate cancer than they are about skin cancer, despite it being the UK’s most common cancer.

ENDS

 

Notes to Editors

Mole and Skin Check Guidelines: Information on the signs of skin cancer for well-being, hair and beauty professionals
• The guidelines are available for download from the British Association of Dermatologists’ website at: www.bad.org.uk/melanoma-taskforce

About the Melanoma Taskforce and the British Association of Dermatologists
• The Melanoma Taskforce is a panel of skin cancer experts brought together by Siân James MP, to look at how the prevention and treatment of skin cancer, and in particular melanoma, can be improved. The group comprises leading dermatologists, oncologists, nurses, surgeons and representatives from the National Cancer Action Team and the National Cancer Intelligence Network as well as patient groups, charities and professional bodies including Cancer Research UK, Teenage Cancer Trust, Skcin (The Karen Clifford Skin Cancer Charity), and the British Association of Dermatologists. The cost of administration of the Taskforce is funded by Bristol-Myers Squibb who hold no editorial control over the work of the group.
• The British Association of Dermatologists is the professional organisation for dermatologists in the UK. It provides free patient information on skin diseases and runs a number of high profile campaigns, including Sun Awareness and a skin cancer early detection campaign.

Endorsing Organisations
• The Melanoma Taskforce and the British Association of Dermatologists are delighted to have the support of nine leading industry bodies in the development and distribution of these guidelines. The endorsing organisations are: the British Association of Beauty Therapy and Cosmetology; the British Association of Skin Camouflage; the British Barbers’ Association; the Federation of Holistic Therapists; the Hairdressing and Beauty Industry Authority; the National Association of Screen Makeup Artists and Hairdressers; the Safe Beauty Association; SkillsActive; and the Hairdressing Council.

Background
• The creation of guidelines to help well-being, hair and beauty professionals who come into contact with people’s skin to spot the signs of skin cancer was one of the key recommendations made to Government by the Melanoma Taskforce in its ‘2015 Skin Cancer Visions’ report. The recommendation called for: “Clear and targeted information for professionals that come into contact with people’s skin, including pharmacists, hairdressers, physiotherapists and swimming instructors.”

Skin Cancer Statistics
• According to figures published by Cancer Research UK in 2011:
o It is estimated that around 100,000 new cases of skin cancer are diagnosed in the UK annually, making it the most common type of cancer;
o In 2008, more than 11,760 people in the UK were diagnosed with melanoma, which represents a quadrupling of the disease’s incidence since the 1970s;
o The majority of cases of skin cancer are preventable;
o The main cause of skin cancer is too much UK light from the sun or sunbeds;
o In 2008, over 2500 people in the UK died from skin cancer and there is evidence that this figure will continue to rise as young people who have experienced sun damage through over-exposure to the sun and sunbeds have an increased chance of developing skin cancer later on in life;
o Melanoma is now the second most common cancer in young adults, aged between 15 and 34, while almost one third of all cases occur in people under-50.

MP Awareness of Skin Cancer
• A survey of MPs conducted by ComRes for the Melanoma Taskforce indicated that concern about skin cancer is common within the House of Commons, with a majority of MPs (67%) either having been concerned themselves about a mole or having a family member who has been concerned.
• The survey indicated however, that there is considerable uncertainty among MPs about the incidence and mortality rates from skin cancer and more than two in five (41%) MPs admit that their knowledge of the disease is ‘limited’ or ‘non-existent’.
• ComRes surveyed 156 MPs by self-completion postal and online questionnaires between 6th and 24th May 2011. Data was weighted to reflect the exact composition of the House of Commons. 

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Sticky tape could prove new tool in fight against most common cancer

Adhesive tape could provide the latest weapon in skin cancer detection, new research in the British Journal of Dermatology reveals.

A team of scientists in the United States has found that cells removed from the skin by an adhesive tape, applied to the skin and then stripped away, can provide vital clues that signify whether or not a lesion is a melanoma skin cancer.

The scientists tested a process called ‘epidermal genetic information retrieval’ (EGIRTM) which uses tape to painlessly remove skin cells from the outer layer of the skin’s surface.

Melanoma often occurs in an existing mole (or ‘nevus’) although it can also appear as a new mole or lesion. Currently, the primary means of diagnosing a melanoma is to remove it surgically and evaluate it under a microscope.

The scientists looked at 202 pigmented lesions* that required biopsy because they were deemed suspicious for melanoma, at 18 sites across the US. All samples used in the study were also biopsied and their diagnosis confirmed by histopathology (under a microscope), as per standard care for skin cancer. As a control, each subject’s normal skin was also sampled by tape stripping.

The technology correctly identified every lesion containing either in situ (early stage) or invasive melanoma, as confirmed by the biopsy. According to the study’s authors, these results are more accurate than any currently available melanoma detection tool.

The process worked by analyzing ribonucleic acid (RNA) from the skin samples on the tape, to profile which genes are present in cancerous as opposed to non-cancerous skin. RNA is a type of molecule, similar to DNA, which carries genetic information.

The researchers looked at how genes are expressed differently between pigmented lesions (both melanoma and nevi) and control skin specimens featuring no pigmented lesions. They then used the information regarding the different genes expressed in the melanomas and nevi to create a classifier, or ‘key’, to identify 17 genes that indicate both in situ and invasive disease. The biological functions of genes in the 17-gene classifier are already known to be primarily involved in cell death, cellular development, hair & skin development, cancer and neurological disease. In addition, two are used as clinical drug targets for treatment of metastatic melanoma. These results demonstrate that most of the genes in this classifier, which distinguishes melanoma from non-cancerous lesions, are involved in melanoma and cancer.

Nina Goad of the British Association of Dermatologists said: “Skin cancer is the most common type of cancer in the UK and is rising rapidly. There are three types of skin cancer and melanoma is the most dangerous, resulting in over 2,200 deaths a year. Early detection is crucial for successful treatment. If a melanoma is detected early and fully removed, it can be cured, but if it is detected late, the cancer can spread to other parts of the body and can prove fatal. Any new technology that supports early and accurate detection of a suspicious mole, so that the patient can be seen promptly by a dermatologist for treatment, is a positive step forward.”

In the study, the authors explained: “We have demonstrated that EGIR, non-invasive tape stripping of stratum corneum, can be used to detect melanoma. We have identified 312 genes that are differentially expressed between melanoma, nevi, and normal skin. Reducing the number of genes to 17 for the purpose of a ‘classifier’, a more practical number that could be tested clinically, was also found to be accurate.”

The 17-gene classifier also falsely identified 13 nevi as melanoma, raising the question of why these were misclassified. The majority of the 13 nevi that were grouped together with melanomas were ‘dysplastic nevi’, also known as ‘atypical moles’, which means that they look different to ordinary moles and are often larger. Each of the 13 false positive specimens was reviewed by dermatopathologists. In doing so, it was determined that one of 13 false positives actually harboured a melanoma, but this is not thought to be the case with the other samples. Another possibility raised in the study is that this new method can detect molecular changes prior to the development of morphological abnormalities in melanoma cells. According to the study’s authors, if these results can be confirmed, it would suggest the EGIR-based genomic assay may be a more sensitive means to detect melanoma than the standard histopathological review.

-Ends-

*The 202 samples included superficial spreading melanoma, nodular melanoma and lentigo maligna, often misdiagnosed as solar lentigo, a sun spot.

Notes to editors:

1. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists

2. For more information please contact: Nina Goad, British Association of Dermatologists, Phone: 0207 391 6355, Email: nina@bad.org.uk, Website: www.bad.org.uk

3. Articles in the BJD can be viewed online: www.brjdermatol.org
British Journal of Dermatology: "Non-Invasive Genomic Detection of Melanoma". The study is now available online in the journal’s ‘Accepted Articles’ section (Accepted Articles have been accepted for publication in BJD, but have not undergone the editing and proof-correction process). The final version will appear in the actual journal later this year (date TBC).

4. Support for this investigation was provided by DermTech International, Inc. (La Jolla, CA), who also provided the tape strip packets used for sample collection. To contact DermTech, please visit www.dermtech.com. Contact details for the study's authors can be found in the full study, available at www.brjdermatol.org.

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com 

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Warning over unlicensed skin cream

The British Association of Dermatologists is warning people in the West Midlands not to buy an illegal, unlicensed cream claiming to treat skin problems, after a number of people have suffered ill health after using it.

At least six children treated with the cream by their parents have been seen at Birmingham Children’s Hospital, with other cases seen in Oxford and West Bromwich.

The product, called Soraderm, is believed to be available at a number of grocery shops in the West Midlands area. While there is a licensed product of the same name, this product is unrelated and contains a powerful steroid.

Two of the children seen at Birmingham Children’s Hospital, had been previously treated for eczema and developed skin problems following use of Soraderm. One developed a severe widespread skin infection while the other suffered eye problems.

The product contains clobetasol propionate, a potent, prescription-only corticosteroid (steroid hormone), which is used to treat various skin disorders including eczema and psoriasis, but only under the supervision of a doctor and in carefully controlled doses. Possible affects of using this cream include thinning of the skin, infection, and absorption into the bloodstream. Children are more susceptible as the steroid used is too strong for use in children.

The package insert gives a market address in Pakistan but makes no reference to any known pharmaceutical company. The product is being sold for approximately £12.99 for a small jar.

Nina Goad of the British Association of Dermatologists said: “At first, this cream can seem to work on disorders like eczema, so patients keep using it. However, it works initially because it contains a strong steroid, but this type of drug should definitely only be used under medical supervision, and certainly not in unlicensed creams.

“Furthermore, some of those affected cancelled their clinic appointments because at first the cream seemed to work, only to then develop severe complications, like skin infections. The fact that parents are using this on their children is a huge worry as it is far too strong for young skin. We would advise people to steer well clear of illegal, unlicensed products, whatever the packaging says or whatever positive claims are made about it online.”

Note to editors:
The MHRA is currently investigating this issue.
Images of the product’s packaging are available on request.
Case studies are not currently available.
We cannot at this time identify the vendors of this product due to an ongoing investigation.


The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

For more information please contact: Nina Goad, Communications Manager, British Association of Dermatologists, Phone: 0207 391 6355, Email: nina@bad.org.uk, Website: www.bad.org.uk 

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Study sheds light on who is most at risk of skin cancer in Ireland

A study into the most common types of skin cancer has found striking risk factors associated with where people live and how rich or poor they are, according to new research in the British Journal of Dermatology.

The study, released online today, examined incidence rates in Ireland for the two commonest types of skin cancer, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), over a ten-year period.* The researchers looked specifically at two issues: the geographical locations where these cancers are most common, and the socioeconomic status of the patients.

People living in cities were found to have a far higher risk of developing BCC, the most common type of cancer, with women a massive 48 per cent and men 35 per cent more likely to develop the disease in the most urban compared to rural areas.
However for the other type of skin cancer studied, SCC, while this again affected women more in urban areas, the situation for men was very different, with risk almost 10 per cent higher in the areas with the highest, compared to the lowest, percentage of farmers (i.e. rural rather than urban areas.)

Risk by location

Looking at all non-melanoma skin cancers (BCC and SCC combined), incidence was higher than average along the coast, particularly in three spots along the west coast (Kerry in the south, Mayo in the mid-west and Donegal further north), and in and around the two main cities, Dublin and Cork. The geographical distribution was similar in men and women, although higher rates were found in rural areas in men than in women.

However, when BCC and SCC were considered separately, very different geographical patterns became apparent. While the coastal and city areas proved to have the highest incidence rates for both SCC and BCC, interestingly, BCC seemed especially prevalent in cities and SCC in coastal areas.

The highest rates of BCC were concentrated in urban areas like Dublin, Cork, Galway and Waterford and a few coastal areas in the south and west of the country. The distribution was similar in males and females. For SCC, in contrast, higher risks were seen more commonly on the coasts (on the south, mid and north-west coast) and in the north-east, and risk was raised only in parts of Dublin, rather than throughout the city.

People living in the most densely populated areas were far more likely to develop a BCC – men in the most urban areas were found to have a 35 per cent and women a 48 per cent higher risk, compared to people in rural areas.

Interestingly, while the areas of highest risk were the same for men and women for BCC, they were very different between the sexes for SCC, which affected women most in the cities and men most in rural and farming communities, especially in the south-west.

Who was most affected

BCC risk in men and women was significantly higher in more affluent people (those living in the least deprived areas). In fact, for both sexes, people living in the most deprived areas had a 14 per cent lower risk of being diagnosed with BCC than those in the least deprived areas.
The same principle was true for SCC in men (it was more likely to affect more affluent men) but interestingly not for women.

For women, geographical location seemed to be a greater risk factor than socio-economic status, with risk of both BCC and SCC higher for women in the most densely populated areas (cities).

What the findings mean

Solar radiation is the major non-melanoma skin cancer risk factor. However, in Ireland, sun exposure is highest in the south-east of the country, where the rates of skin cancer were low. Moreover, differences in sunshine across the country are rather small (only one daily hour difference between the lowest and highest levels). Therefore, levels of sun in the different geographical areas are unlikely to account for the differing risk rates. Likewise, differences in people’s skin types do not vary greatly enough across the country to account for the variations.

Exposure to UV radiation would be expected to be higher in areas with high proportion of outdoor workers (e.g. in agriculture, fishing, construction). Higher risks (particularly of SCC, for which occupational UV exposure appears to be most impactful) were found in coastal areas where workers from the fishing industry may have been more exposed to UV as may some farmers working close the sea.

Another possible explanation is that the least deprived individuals (who are shown to have increased risk) tend to move out from cities to more pleasant coastal locations later in life, therefore increasing incidence in those areas. This would especially have an impact on BCC risk, since these cancers are associated with burning and intermittent UV exposure (such as you might get from a beach holiday) rather than more long-term, cumulative exposure (such as you might get from working outdoors.)

Geographical differences in the intensity of detection of skin cancer may also explain the findings. A 2003 national report** showed large variation in distribution of dermatologists across the country. In particular, a lack of dermatologists in the Midlands and North-Western health boards was identified. This lack of dermatologists could result in cases of skin cancers going undiagnosed in these areas.

Linda Sharp of the National Cancer Registry and one of the study’s authors said: “BCC in both sexes and SCC in females were more common in residents of more densely populated areas. Since BCC is mostly non-fatal, these differences may partly reflect variations in awareness and use of cancer services. In Ireland, rural residents have the lowest access to GP services. In addition, studies show that individuals with the lowest incomes are significantly less likely to be referred to a specialist. It is possible that people living in urban or less-deprived areas may be more aware of the risks of UV exposure and therefore more likely to report potential skin lesions to their GP.”

Another possibility is that more affluent people may be more likely to take foreign holidays, while those in urban areas are likely to have better access to airports for holidays abroad and businesses offering tanning facilities. In Ireland, census data shows that Dublin residents are much more likely to travel abroad than those from elsewhere. Moreover, the percentage who had used sunbeds in 2007 was higher in urban than rural areas (9% vs 4%) and in those of higher social class. In addition, the likelihood of people protecting themselves from skin cancer may differ in urban and rural areas and by socioeconomic status.

Nina Goad of the British Association of Dermatologists said: “This study provides a fascinating insight into who is most likely to be diagnosed with skin cancer, our most common cancer. One very interesting hypothesis for the variations we are seeing in different areas and different levels of wealth, relates to diagnosis of skin cancers. If the striking variations in risk factors that this study reveals are in some part down to the fact that people in rural locations and people in more deprived areas are less likely to see their GP with a possible skin cancer, or are less likely to have their lesion diagnosed by a dermatologist, then this shows that we have a lot of work to do to address these issues and to try to raise the profile of self-check messages among these groups.”

Background

Collectively, BCC and SCC are called non-melanoma skin cancer and are the UK’s most common cancer, with over 70,000 new cases diagnosed across the UK annually, 5,000 of which are in Ireland. However, as data collection for these cancers is poor, the actual figure is thought to be much higher, with an estimated actual figure of 100,000 new cases every year across the UK.

Ultraviolet (UV) exposure from the sun or sunbeds is thought to be responsible for the vast majority of skin cancers, but UV plays a different role on BCC and SCC.
SCC is largely associated with occupational sun exposure, for example people who work outdoors and have cumulative sun damage, while BCC is more strongly associated with intermittent sun exposure and sunburn, such as from beach holidays, and especially early in life. Both types are more common in paler skinned people.

Previous studies into melanoma, the most deadly but least common type of skin cancer, have found that it is more common in more affluent people, and this has been attributed in part to increased foreign travel in these groups. However, this is the first UK study to look at the more common non-melanoma skin cancers.

Ireland is an ideal location for such a study as non-melanoma incidence rates are high by international standards, and data collection is more uniform in one location as opposed to a country-to-country comparison. Additionally, skin types and UV levels are similar across the country, meaning these risk factors are constant and will not lead to significant inconsistencies of results in different geographical locations (i.e. where one area has been shown to have higher rates of BCC, it is unlikely to be because people in this area are paler skinned or that it is sunnier than elsewhere in Ireland.)


*47,347 cases diagnosed 1994-2003. 14,236 had SCC and 32,226 had BCC.
** Comhairle na nOspidéal. Report of the Committee on Dermatology Services –
November 2003. Available at www.comh-n-osp.ie

Notes to editors:

1. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists

2. For more information please contact: Nina Goad, British Association of Dermatologists, Phone: 0207 391 6355, Email: nina@bad.org.uk, Website: www.bad.org.uk

3. Articles in the BJD can be viewed online: www.brjdermatol.org
British Journal of Dermatology: Geographical, urban/rural and socio-economic variations in nonmelanoma skin cancer incidence: a population-based study in Ireland. A.E. Carsin,*†‡ L. Sharp* and H. Comber*
*National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
†Centre for Research in Environmental Epidemiology (CREAL), C. Dr Aiguader, 88, 08003 Barcelona, Spain
‡Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
Accepted for publication, 22 November 2010.

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com
 

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