So go ahead and step out in your favorite flip-flops for summertime strolls and parties. (P.S. Be sure to protect your feet with sunscreen.) Then, step into well-cushioned shoes when walking on concrete or pavement and exercising to dodge painful problems, say Mount Sinai School of Medicine Orthopaedic doctors who treat an influx of flip flop injuries each summer. Here’s why!

Flip-flops offer limited support.

1. People grip and hold flip-flops in place with their toes. Result: This motion changes the way you walk and can stress the toes, ankles, legs, hips, and back.
2. Flat and flimsy shoe beds provide inadequate foot support for all-day wear. Result: Arch pain, plantar fasciitis, and nerve issues.
3. Lack of shock absorption. Result: Pain in feet, legs, hips, and back.

Flip-flops offer limited coverage.

1. Few people understand or think of the foot as a place where skin cancer can arise. Result: Foot melanoma can be deadly. Mount Sinai Podiatrist Dr. Bryan Markinson reports a sharp rise in foot melanoma among his patients. Alert to sandal wearers: Remember to apply sunscreen to your feet!
2. Flip-flops leave toes and nails uncovered and unprotected. Result: Broken toes and toenails.
3. Feet can roll off the shoe. Result: Cuts and infections.

Mount Sinai’s Leni and Peter W. May Department of Orthopaedics specializes in surgery of the foot and ankle, knee, hip, hand, elbow, shoulder, and spine; total joint replacement for knee, hip, foot, ankle, and shoulder; microvascular surgery; cancer surgery; and minimally invasive surgery.

Flip-Flops For Summer Fun The Saturday Evening Post

Previous studies suggest that taking nonsteroidal anti-inflammatory drugs, or NSAIDs, which include aspirin, ibuprofen, and naproxen, as well as a variety of other nonprescription and prescription drugs, can decrease an individual’s risk of developing some types of cancer.

Sigrún Alba Jóhannesdóttir, B.Sc., of Aarhus University Hospital in Denmark, and her colleagues analyzed medical records from northern Denmark from 1991 through 2009 and identified 1,974 diagnoses of squamous cell carcinoma, 13,316 diagnoses of basal cell carcinoma, and 3,242 diagnoses of malignant melanoma. They compared information, including prescription data, from these patients with information from 178,655 individuals without skin cancer.

Individuals who filled more than two prescriptions for NSAIDs had a 15 percent decreased risk for developing squamous cell carcinoma and a 13 percent decreased risk for developing malignant melanoma than those who filled two or fewer prescriptions for the medications, especially when the drugs were taken for seven or more years or taken at high intensity.

Individuals who took NSAIDs did not seem to benefit from a reduced risk of developing basal cell carcinoma in general, although they did have a 15 percent and 21 percent reduced risk of developing this type of cancer on less-exposed sites (body areas other than the head and neck) when they took them long term or at high intensity, respectively.

“We hope that the potential cancer-protective effect of NSAIDs will inspire more research on skin cancer prevention,” said Ms. Jóhannesdóttir. “Also, this potential cancer-protective effect should be taken into account when discussing benefits and harms of NSAID use.”

Click here for sun protection tips from the World Health Organization.

Source Article: “Nonsteroidal anti-inflammatory drugs and the risk of skin cancer: A population-based case-control study.” Sigrún Alba Jóhannesdóttir, Ellen T. Chang, Frank Mehnert, Morten Schmidt, Anne Braae Olesen, Henrik Toft Sørensen. CANCER; Published Online: May 29, 2012 (DOI: 10.1002/cncr.27406).

Summer Skin Care The Saturday Evening Post

Researchers zeroed in on women with a history of non-melanoma skin cancer (such as basal or squamous cell cancers) enrolled in the Women’s Health Initiative, a large clinical trial involving 36,282 postmenopausal women who received either placebo or 400 international units of vitamin D and 1,000 milligrams of calcium carbonate per day.

“In preventive medicine, we want to target people most at risk for the disease,” said dermatologist Jean Tang, MD, PhD, lead author of the study in a university report. “If you previously had a non-melanoma skin cancer, calcium plus vitamin D might reduce your risk of the more deadly melanoma.”

But the supplements didn’t help everyone. Study data show melanomas were detected in about as many women without a history of non-melanoma skin cancer who took the supplements as in their placebo-group counterparts.

The study was published online on June 27 in the Journal of Clinical Oncology.

Can Vitamin D and Calcium Help Prevent Skin Cancer? The Saturday Evening Post

Post editors interviewed dermatology specialist Babar K. Rao, M.D., of The Skin & Cancer Center of New York, The American Skin & Cancer Center, NJ, and West Coast Skin & Cancer Medical Center, California, to find out more about VivaScope laser technology to diagnose basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma, the most deadly of all skin cancers.

The advanced device system, in use in a growing number of clinical dermatology practices across the country, provides more accurate examination of deep skin layers than previously possible without removing tissue. Post editors asked Dr. Rao about the type of worrisome skin lesions that might still require pathologist-read biopsies:

Dr. Rao: Current limitations of the current VivaScope device are related to lesion position and thickness. Many lesions that concern dermatologists or patients are located in easy-to-reach places on the skin. Sometimes, however, skin cancer occurs on the ears and sides of the nostrils—locations that are hard to access with any instrument, including the VivaScope. Future modifications of the device are expected to make it easier to manage these areas. In addition, some lesions may be too thick to visualize with the VivaScope. But most early skin lesions seen by dermatologists are thin.

Post: Is the new technology covered by insurance providers?

Dr. Rao: Medical insurance reimbursement is a complicated system. There are two facets to this technology: imaging and reading. To date, no insurers make payments for the imaging, so patients pay for this from their own pockets. But some insurers are paying for reading the images as the process is very similar to today’s standard; both involve looking directly at cells. The device maker is actively working to help experts understand the imaging and reading components to ensure that patients have access to this technology in the short term.

Post: Is it difficult for physicians to learn how to utilize VivaScope technology?

Dr. Rao: A physician or his assistant can learn within a few days to acquire what we call “confocal” images. In contrast, reading these images and using them to make a diagnosis is not for all physicians. In general, a skin pathologist would have the expertise to interpret these cases. The training curve involves becoming familiar enough with the equipment to feel confident in making the diagnosis, so it’s important that the image reader gain as much experience as possible.

We will be hosting a CME-accredited training course in confocal image interpretation at the UDMNJ Robert Wood Johnson School of Medicine in May of 2011 that will assist skin pathologists and dermatologists to further their education and experience. A variety of other education options exist today, including online training, in-person training courses and lectures and discussions at the American Academy of Dermatology society meetings.

Post: What do patients think of the new technology?

Dr. Rao: Patients are very excited and curious and they want to know more about it. Given the option, most people prefer to avoid being cut. Many patients with a history of skin cancer have had numerous biopsies and I’m happy that my practice can offer an alternative to some of them.

Post: Are there any misconceptions about the device that you can address?

Dr. Rao: There is a general feeling among dermatologists that the VivaScope tool is too expensive for use in the private-practice. This simply isn’t true. I have two VivaScopes, one in my Manhattan practice and one in my Fresno practice. The Company has made it quite easy for me to access, use, and grow my practice with this device.

Another misconception is that this noninvasive imaging tool is still in development, but the VivaScope has been FDA-cleared since 2008, and its manufacturer has since been further refining the device system to fit within the current workflow of the practice.

Post: What advantages does the new technology offer to you as a dermatologist?

Dr. Rao: Personally, for the first time in my dermatology experience, I can see cellular details of disease versus normal tissue without cutting. I know when I must excise a lesion and when I can be confident in leaving one alone. Early detection is the key to management of skin cancer and this device is changing the way that we detect, follow, and manage the disease.

Only your physician can determine whether VivaScope technology from Lucid, Inc., is best for you. For more, interested readers can find a doctor in their area who utilizes the advanced imaging system or request an information packet for their doctor.

Detect Skin Cancer—in Minutes The Saturday Evening Post

“No one wants to think about developing a disfiguring, even deadly, disease like skin cancer, so many Americans live in a state of denial,” says Joshua Fox, M.D., a leading dermatologist and medical director of Advanced Dermatology of New York and New Jersey. “Most people know they are supposed to be checking their skin monthly for changes that might be cancer, but they aren’t exactly diligent about it. It’s something that gets put off for later, often indefinitely.”

Checking your skin regularly, and making an appointment to have your dermatologist do the same, is the best and only way to catch skin cancer before it spreads.

“For the past twenty-five years, we’ve told people to pay attention to the ABCDs of pigmented skin irregularities,” Dr. Fox continues. “Checking for asymmetry, border irregularity, color variation, and diameter more than 6 mm (about 1/4 inch) is still the key to identifying a problematic growth among a bunch of innocuous-looking freckles and moles.”

Here are Dr. Fox’s five rules to save your skin:

1. Make it a habit to check your skin at home.

Inspect yourself, head to toe, once a month. “Many cases of melanoma and other cancers develop on the scalp,” Dr. Fox says. “These cancers can be deadly, but unfortunately, most people don’t check the tops of their heads very often.”

Helpful Hint: Look over every inch of your birthday suit, even in areas where you’ll need a hand mirror to get a good look.Check the palms of your hands, your nails, and the soles of your feet, too.

2. Know what is normal.

In most cases, a normal mole is a uniform shade of brown, tan, or black, and can be flat or raised, round or oval. Some moles are present at birth and others develop later in life, especially in areas that get lots of sun.  Once moles appear, they most often remain the same size, shape, and color. Others eventually fade and disappear. “Almost everybody has moles, and almost all moles are harmless,” Dr. Fox says. But people with lots of moles, more than 50, are at a higher risk for skin cancer.

Helpful Hint: Be on the lookout for flesh-colored, pearl-like bumps or pinkish or reddish patches of skin that flake, scale, or even bleed. They can be basal or squamous cell carcinomas.

3. Pay attention to changes in your skin.

Be on the lookout for new marks and check for changes in old ones. Also note whether skin around a freckle or mole becomes crusty, for example, or spots start to feel itchy or sore.

Helpful Hint: “Spots on the skin come in all shapes and sizes, and not every mark you see will be cancer,” Dr. Fox says. “But if you see something that really stands out, what dermatologists call an ‘ugly duckling’, be sure to tell your dermatologist in a timely manner.”

4. Schedule an annual skin check with your dermatologist.

Most people should see the dermatologist once a year. At this exam, the doctor will check your skin and discuss any changes that the two of you have found.

Helpful Hint: Anyone who’s had skin cancer already or who has other significant risk factors should make an appointment at least every six months.

5. Find a dermatologist who uses dermatoscopy technology.

Also known as epiluminescence microscopy (ELM), or surface microscopy, this is a relatively new method of screening that’s extremely effective at identifying cancers, helping the doctor distinguish malignant lesions from benign ones, says Dr. Farkas, who uses a dermatoscope in her practice at Advanced Dermatology. “The dermatoscope uses polarized light and a magnifying lens to let us ‘see’ the skin more clearly,” she explains. “It significantly increases the accuracy of the exam, meaning we can detect problems much more reliably than with the naked eye.”

Helpful Hint: Next week, Medical Update offers bonus coverage from dermatology specialist Dr. Babar Rao about VivaScopes with advanced laser technology that provides optical images of cells at and below the surface of living skin to detect and diagnose skin cancer—without a biopsy.

5 Tips to Spot Skin Cancer The Saturday Evening Post

Unlike other cancers, malignant melanoma develops on the body’s surface. And spotting its distinctive visual clues remains critical to saving lives, according to new research reported online on CA First Look http://caonline.amcancersoc.org/papbyrecent.dtl from the New York University School of Medicine Melanoma Cooperative Group, which recommended in 1985 that attention to asymmetry (A), border irregularity (B), color variegation (C), and diameter more than 6 mm (D) of colored skin lesions could promote earlier recognition of the dangerous disease.

Approaches to detecting melanoma have evolved dramatically in the past 25 years. In the 1990s, dermoscopy revealed new subsurface features to help differentiate between melanoma and ordinary moles. Today, advanced computer-based technologies are helping doctors better identify the lesions that require further inspection.

Examining tumor cells under a microscope remains the gold standard for diagnosing melanoma. But a “good eye” remains key.

“From the development of the ABCDs through current attempts that use complex computer algorithms and genetic markers, a clinician’s ability to detect melanoma in its earliest form has been augmented,” write the authors. “However, a ‘good clinical eye’ is still fundamental to selecting the lesions for evaluation among the sea of those that are prevalent.”

Melanoma grows slowly and may occur anywhere on the skin. Regular and thorough skin checks can discover early signs of trouble. Always report suspicious signs to a dermatologist right away.

Click here http://www.saturdayeveningpost.com/2009/05/30/wellness/medical-update/skin-cancer-melanoma-skin-exams.html for more on how to screen yourself (and your friends and family) for skin cancer and to download the Body Mole Map from the American Academy of Dermatology.

Click here http://www.cancer.gov/aboutnci/servingpeople/snapshots/melanoma.pdf for melanoma research from the National Cancer Institute.

Melanoma Update The Saturday Evening Post