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    <recommendedItem id="20100101_19_330"
                     title="Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/Nephrology/KidneyTransplantation/tb/18200?impressionId=1265780925478"
                     
      Monitoring two types of immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, British investigators reported.&lt;br&gt;
&lt;br&gt;Increased levels of T-regulatory cells (Tregs) more than doubled the risk of squamous cell cancer of the skin. Decreased levels of natural killer (NK) cells were associated with more than a five-fold increased risk of skin cancer.&lt;br&gt;
&lt;br&gt;Both immune parameters had substantially greater predictive power than a history of squamous-cell skin cancer, according to an online report in the &lt;em&gt;Journal of the American Society of Nephrology&lt;/em&gt; by a team of Oxford University investigators.&lt;/p&gt;
&lt;p&gt;&quot;Squamous cell cancer of the skin affects about 30% of kidney transplant patients after 10 years of immunosuppression,&quot; Robert Carroll, MD, currently of Queen Elizabeth Hospital in Woodville, Australia, observed in a statement.&lt;/p&gt;
&lt;p&gt;&quot;A small number of patients develop multiple skin cancers per year, but there is no laboratory test to determine which transplant recipients will develop multiple skin cancers in the future.&quot;&lt;/p&gt;
&lt;p&gt;&quot;If a test can confirm high risk of skin cancer development, this may help clinicians to tailor immunosuppressive regimens for individual patients,&quot; he added.&lt;/p&gt;
&lt;p&gt;Long-term immunosuppression, such as that required for transplant recipients, confers an increased risk of squamous-cell skin cancer.&lt;/p&gt;
&lt;p&gt;Estimates of the magnitude have ranged as high as 200 times greater than the general population, the authors wrote. Additionally, 3% of organ transplant recipients require extensive plastic surgery each year as a result of skin cancer lesions.&lt;/p&gt;
&lt;p&gt;Age at transplantation and the immunosuppression dosage are the principal determinants of skin-cancer risk, and the dosage of immunosuppression also influences the risk of metastasis from squamous-cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;In the general population, cancer has been associated with increased levels of Tregs, including CDR&lt;sup&gt;+&lt;/sup&gt;CD25&lt;sup&gt;high&lt;/sup&gt;FOXP3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt;CD28&lt;sup&gt;-&lt;/sup&gt; cells. The same types of cells could play a role in the risk of skin cancer among organ transplant recipients, the authors wrote.&lt;/p&gt;
&lt;p&gt;Within the tumor microenvironment, Tregs may impair the antitumor activity of CD8&lt;sup&gt;+&lt;/sup&gt; and NK cell. However, in organ transplant recipients, Tregs help control or prevent rejections and may help improve long-term outcomes.&lt;/p&gt;
&lt;p&gt;Different immunosuppressive drugs affect Tregs differently, the authors continued. Sirolimus (Rapamune), for example, increases the number of FOXP3&lt;sup&gt;+&lt;/sup&gt; cells, whereas cyclosporine decreases Treg numbers.&lt;/p&gt;
&lt;p&gt;&quot;Tregs have not been assessed in relation to cancer after transplantation,&quot; the authors wrote. &quot;We therefore investigated the hypothesis that squamous-cell cancer in kidney transplant recipients would be associated with an increased number of Tregs.&quot;&lt;/p&gt;
&lt;p&gt;To examine the hypothesis, investigators phenotyped peripheral blood from 65 kidney transplant recipients with squamous skin cancer and 51 recipients without skin cancer, matched for age, sex, and duration of immunosuppression.&lt;/p&gt;
&lt;p&gt;They also quantified lymphocyte populations in skin cancer lesions from a subset of 25 patients and matched them with 25 other nontransplant patients with squamous cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;The kidney transplant recipients had a median follow-up of 340 days. The investigators found that a concentration of &amp;gt;35 peripheral FOXP3&lt;sup&gt;+&lt;/sup&gt;CD4&lt;sup&gt;+&lt;/sup&gt;CD127&lt;sup&gt;low&lt;/sup&gt; regulatory T cells/&amp;#181;L was associated with a hazard ratio for squamous cell skin cancer of 2.48 (95% CI 1.04 to 5.98).&lt;/p&gt;
&lt;p&gt;An NK cell count &amp;lt;100 cells/&amp;#181;L was associated with a skin cancer hazard ratio of 5.6 (95% CI 1.31 to 24). A history of squamous cell cancer of the skin increased the risk of skin cancer recurrence by a third (HR 1.33, 95% CI 1.15 to 1.53).&lt;/p&gt;
&lt;p&gt;&quot;If similar immune phenotypes are predictive in other kidney transplant recipient populations, then immune phenotype method has the potential to inform immunosuppressive regimen manipulation in kidney transplant recipients at high risk for developing multiple squamous cell cancers,&quot; the authors concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1446"
                     title="SID: Actinic Keratoses Have Cyclic Nature"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14130?impressionId=1265780925478"
                     
       MONTREAL, May 8 -- Actinic keratoses are dynamic lesions with intermittent expression in subjects with even extensive damage, according to an 11-month study of their natural course. 
              &lt;p&gt;&quot;At any one time, less than half of the lesions are present clinically,&quot; said Craig Elmets, M.D., who reported his findings here at the Society for Investigative Dermatology meeting. 
              &lt;p&gt;The frequent regression and recurrence of lesions has implications for the treatment of actinic keratoses (AK), which are precursors to squamous cell carcinomas, said Dr. Elmets, of the University of Alabama in Birmingham. 
              &lt;p&gt;&quot;In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions,&quot; Dr. Elmets said. &quot;If one is going to treat individual lesions, then they need to be treated very aggressively because at any one time only a minority of the AK are present.&quot; 
              &lt;p&gt;Dr. Elmets and colleagues followed AK lesions in 26 individuals with extensive actinic damage. At baseline, the study participants had between 10 and 40 actinic lesions and at least one prior histological diagnosis of an AK or nonmelanoma skin cancer. 
              &lt;p&gt;Mapping of the lesions was done at baseline and again at three, six, nine, and 11 months. The lesions were also biopsied at both baseline and the end of the study. 
              &lt;p&gt;&quot;If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,&quot; Dr. Elmets explained. 
              &lt;p&gt;At baseline, there was a total number of 610 AKs in the study group (mean 23.5 per individual), and this number was not significantly different at the end of the study, despite the development of 973 new lesions over the 11-month period. 
              &lt;p&gt;About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, Dr. Elmets said. &quot;A total of 51 of the lesions regressed twice.&quot; 
              &lt;p&gt;Using a histologic grading scheme that was based on a cervical dysplasia model, he noted little progression in severity of lesions in terms of proliferation, atypia, or both. 
              &lt;p&gt;&quot;The histologic appearance seems to accurately correlate with the clinical appearance, and over the course of 11 months there was little evidence of histologic progression,&quot; he said. 
              &lt;p&gt;AK lesions have strong predictive value for individuals who will eventually develop basal cell or squamous cell carcinomas,&quot; Dr. Elmets said, &quot;but until now their natural history has not been well understood.&quot;   
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Elmets did not disclose any conflicts of interest or funding for the study.  &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1453"
                     title="SID: Melanoma in U.S. Shows Rapid Increase"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14141?impressionId=1265780925478"
                     
      MONTREAL, May 11 -- The incidence of melanoma in the U.S. increased rapidly over a 12-year period -- across socioeconomic lines and for all tumor thicknesses -- according to a study reported here. 
              &lt;p&gt;
              &lt;p&gt;During the study period from 1992 to 2004, the incidence of all thicknesses of melanoma increased from 18.2 per 100,000 to 26.3 per 100,000 (95% CI 25.7 to 27.0) -- an annual increase of 3.1% (&lt;em&gt;P&lt;/em&gt;&lt;0.001), the report said. 
              &lt;p&gt;
              &lt;p&gt;A total of 70,596 new cases was reported over the period.
              &lt;p&gt;
              &lt;p&gt;&quot;This has implications for preventive screening and primary care,&quot; Eleni Linos, M.D., Ph.D., of Stanford University Medical Center, told colleagues at the Society for Investigative Dermatology meeting here. 
              &lt;p&gt;
              &lt;p&gt;&quot;We believe this represents a genuine increase in melanoma cases, not just a sign of better screening,&quot; she said in an interview. 
              &lt;p&gt;
              &lt;p&gt;Her study, published in the &lt;em&gt;Journal of&lt;/em&gt; &lt;em&gt;Investigative Dermatology&lt;/em&gt;, examined data from the Surveillance Epidemiology and End Results (SEER) registry between 1992 and 2004. (See: &lt;a href=&quot;http://www.medpagetoday.com/HematologyOncology/SkinCancer/12377&quot; target=&quot;blank&quot;&gt;Reports of Increases in Melanoma Incidence Are Real&lt;/a&gt;). 
              &lt;p&gt;
              &lt;p&gt;The research focused only on non-Hispanic white subjects, in whom 90% of melanomas occur, said Dr. Linos. 
              &lt;p&gt;
              &lt;p&gt;Melanoma affects both sexes, but during the period of the study, cases involving women outnumbered those in men by a 3:2 margin. 
              &lt;p&gt;
              &lt;p&gt;The steepest increase and highest overall incidence occurred in men ages 65 years and older, with the rate rising from 73 to 126 new cases per 100,000 (CI 120.2 to 132.4). Among women the rate was 51 per 100,000 (CI 50.8 (47.5 to 54.2).
              &lt;p&gt; 
              &lt;p&gt;Among those younger than 65 years, incidence rates were 18.8 cases per 100,000 in men (CI 18.0 to 19.6) and 17.9 cases among women (CI 17.1 to 18.7). 
              &lt;p&gt;
              &lt;p&gt;Fortunately, the increase in overall incidence was not matched by an increase in mortality, which rose by 0.4% annually, with a 2% annual rise in older men. 
              &lt;p&gt;
              &lt;p&gt;&quot;The vast majority of melanomas that are diagnosed are thin, and that is why we have not seen such a dramatic increase in mortality rates,&quot; Dr. Linos explained. 
              &lt;p&gt;
              &lt;p&gt;Researchers examined melanoma trends according to socioeconomic status to determine whether the findings could be explained by better screening in those with higher brackets, and by higher mortality rates in those with lower socioeconomic status. 
              &lt;p&gt;
              &lt;p&gt;Similarly, tumor thickness was examined to determine whether the increased incidence could be explained by more diagnoses of thin, clinically insignificant tumors. 
              &lt;p&gt;
              &lt;p&gt;&quot;We found parallel increases across all socioeconomic groups and thicknesses, representing a true increase in clinically significant tumors,&quot; she said. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Linos reported no conflicts of interest. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
    <recommendedItem id="20090101_19_1463"
                     title="SID: COX-2 Inhibitors May Cut Skin Cancer Rate"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14152?impressionId=1265780925478"
                     
       MONTREAL, May 12 -- A twice-daily dose of celecoxib (Celebrex) over a period of nine months reduced the incidence of nonmelanoma skin cancer by almost 60 percent, according a new study. 
              &lt;p&gt;&lt;p&gt;&quot;COX-2 inhibitors are more effective than sunscreens in inhibiting skin cancer development,&quot; Craig Elmets, M.D., of the University of Alabama, told colleagues at the annual meeting of the Society for Investigative Dermatology. 
              &lt;p&gt;The study enrolled 238 patients with actinic keratoses (AK) and a history of nonmelanoma skin cancer or AK from eight U.S. centers. The mean age of the patients was 65 years; they were mostly male, and virtually all were Caucasian, he said. 
              &lt;p&gt;&quot;The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,&quot; he noted. 
              &lt;p&gt;Subjects in the study had Fitzpatrick skin types I to III, extensive actinic damage with between 10 and 40 AK and prior histologic diagnosis of either AK or nonmelanoma skin cancer. 
              &lt;p&gt;They were excluded if they required treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), although cardioprotective doses of aspirin were allowed, he said. 
              &lt;p&gt;At entry, patients had a mean number of 22 AKs, as well as between 2.1 and 2.5 nonmelanoma skin cancers, Dr. Elmets said. 
              &lt;p&gt;Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dose for arthritis. 
              &lt;p&gt;&quot;We were concerned about cardiovascular abnormalities and GI abnormalities, and, if anything, there was a bias towards patients in the celecoxib group having a prior history of that,&quot; he said. 
              &lt;p&gt;Celecoxib had no apparent effect on the number of AKs at baseline versus completion compared to placebo, he noted. 
              &lt;p&gt;But the results were more positive regarding development of new cutaneous basal and squamous cell carcinomas. 
              &lt;p&gt;&quot;We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,&quot; he said. 
              &lt;p&gt;Looking at the two types of lesions separately, treatment with celecoxib resulted in a 58% reduction in squamous cell carcinomas (SCC), and a 62% reduction in basal cell carcinomas (BCC). 
              &lt;p&gt;&quot;The difference between the [placebo and treated] groups started to become apparent quite rapidly, at three months, and persisted throughout the study,&quot; he said. 
              &lt;p&gt;&quot;We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCC and SCC than the placebo group.&quot; 
              &lt;p&gt;There were no differences in adverse events, serious adverse events, or cardiovascular adverse events between the two groups, Dr. Elmets reported, although during the question period he acknowledged higher blood pressures reported in the treatment group. 
              &lt;p&gt;Of the 238 patients enrolled, 36 and 24 withdrew from the treatment and placebo groups respectively. 
              &lt;p&gt;This study suggests that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than sunscreens, which are only &quot;modestly effective,&quot; said Dr. Elmets. 
              &lt;p&gt;&quot;There&apos;s only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a five-year period of time, and there&apos;s no reduction in basal cell carcinomas.&quot; 
              &lt;p&gt;&quot;The data is very compelling,&quot; commented Maryam Asgari, M.D., a Kaiser Permanente dermatologist in Oakland, Calif. who has conducted similar research. But she cautioned that the study might have been too short to warrant dramatic conclusions. 
              &lt;p&gt;&quot;I know that, typically, for most cancers you would need a study to last two to five years before you would expect to measure an effect,&quot; she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop, she suggested. 
              &lt;p&gt;Dr. Asgari said her own research in the same field has produced opposite results, including a recently completed study showing that NSAIDS -- both selective and nonselective COX inhibitors -- had no apparent effect on the incidence of squamous cell carcinoma. 
              &lt;p&gt;She said a previous paper published by her group also found no protective effect of these drugs on melanomas.
              &lt;p class=&quot;MsoNormal&quot;&gt;
              &lt;p&gt;In addition, she said celecoxib&apos;s lack of effect on AKs is a puzzling result. &quot;You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses, because they both share the same pathway.&quot; 
              &lt;p&gt;Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin -- an important factor that the analysis did not adjust for, she pointed out. 
              &lt;p&gt;&quot;Even low dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.&quot; 
              &lt;p&gt;The study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer, through a contractual agreement with the National Institutes of Health. 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Elmets reported no conflict of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1488"
                     title="SID: Study Links Skin, Psychiatric Problems"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14184?impressionId=1265780925478"
                     
      MONTREAL, May 13 -- People who report skin problems of any kind are also significantly more likely than others to experience depression, anxiety, or psychosis, researchers reported. 
              &lt;p&gt;
              &lt;p&gt;In a cross-sectional study of data from the population-based 2007 National Health Interview Survey (NHIS), skin disease was associated with an odds ratio (OR) of 2.5 for depression/anxiety, and 2.7 for psychosis, according to Nana Smith, M.D., of the University of Rochester. 
              &lt;p&gt;
              &lt;p&gt;&quot;Because this was a cross-sectional study, there&apos;s no way to tell which comes first, the skin disease or the psychiatric diagnosis,&quot; she told colleagues at the annual meeting of the Society for Investigative Dermatology.
              &lt;p&gt; 
              &lt;p&gt;The NHIS, which surveyed 23,393 subjects in 2007, included only two questions that provided information on skin disease, she explained. 
              &lt;p&gt;
              &lt;p&gt;The first question asked subjects if they had experienced any skin problems in the preceding year, and the second question asked if they had received any diagnosis of cancer, followed by the opportunity to specify what type of cancer, including skin cancer. 
              &lt;p&gt;
              &lt;p&gt;Regarding psychiatric conditions, subjects were asked if a physician had diagnosed them with depression/anxiety or with psychosis. 
              &lt;p&gt;
              &lt;p&gt;After adjusting for age, sex and race, the study found that 30% of people with skin disease reported depression, compared with 15% of controls. Likewise, 12% of the skin disease population reported psychosis, versus 5% of controls, she said. 
              &lt;p&gt;
              &lt;p&gt;When the only dermatological condition was skin cancer, the odds of depression or psychosis dropped down to about 1.0, suggesting that &quot;the depression or psychosis that people with skin disease were experiencing did not seem to be due to any skin cancer that they had,&quot; she said. 
              &lt;p&gt;
              &lt;p&gt;In contrast, the odds for the same psychiatric diagnoses among people with other chronic conditions, such as other cancers, hypertension, myocardial infarction, and emphysema were much lower than for those with skin disease, she said. 
              &lt;p&gt;
              &lt;p&gt;&quot;This is an intriguing study, but it doesn&apos;t allow us to do much in terms of moving on to intervention,&quot; said Dr. Smith, who urged dermatologists to consider the value of adding a more specific skin question to the NHIS questionnaire. 
              &lt;p&gt;
              &lt;p&gt;&quot;This would enable us to get some more specific information than we have now,&quot; she said, adding that the cost of an additional question would be in the range of $150,000. 
              &lt;p&gt;
              &lt;p&gt;&quot;It would be important to know whether these people really have skin disease, or do they just have dry skin. Additionally, it would be important to have more details about what types of skin condition are associated with these psychiatric symptoms,&quot; she said. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The National Health Interview Survey is conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, and is administered by the U.S. Census Bureau. 
              &lt;p&gt;Dr. Smith reported no conflicts of interest. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
</recommendedContent>