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Melanoma treated in early stages has good prognosis.

Now that the summer is fast approaching, we should revisit the topic of skin cancer. Today, we will discuss melanoma, next week we will visit non-melanoma skin cancers and in the third week we will discuss appropriate use of sunscreen.

In early stages, surgical removal of melanoma is usually successful. Once the melanoma has spread then the prognosis is grim. Recently, FDA has approved certain drugs to be used in late stage melanoma. But these drugs do not cure the cancer and the side-effects are many. The current prognosis for survival in metastatic melanoma is nine months or less, with 9,000 people dying in the U.S. each year.

For Canadian males, the rate for melanoma has tripled since the late 1960s. For Canadian females, the rates have varied over the years but still show a gradual increase. The death rate from melanoma continues to rise about two percent annually. Approximately, two per cent of melanomas occur in patients under the age of 20 years, and about 0.4 per cent of melanomas occur in pre-pubertal children.

Melanoma arises from cells called melanocytes. These cells contain melanin (melas = black) – a principal pigment responsible for the color of human skin, hair, and eyes. Melanin also acts as a filter to decrease the harmful effects of ultraviolet rays to the dermis.

When the skin is exposed to ultraviolet radiation, there is immediate increase in the number of melanocytes and production of melanin pigment. This results in tanning. The amount of melanin produced is genetically determined. That is why some people burn easily without tanning.

The risk of skin cancer is increased in individuals who spend too much time outdoors; children who have had episodic sunburn, and if there is a family or personal history of skin cancer (especially melanoma). Males are affected more than females.

Melanoma is usually found on the backs or chest in men and lower legs in women. These areas are most exposed to sunlight. Melanoma can also occur in eyes, mouth or internal organs although these areas are not directly exposed to sun.

Examples of melanoma on the abdominal wall skin:
Abdominal wall skin melanoma.
Abdominal wall skin melanoma.

There are four different types of melanomas:
-superficial spreading melanoma: most common, looks like a spreading mole
-nodular melanoma: 10 per cent of cases, looks like a dome rising from a mole
-lentigo maligna: less common, looks like an irregular stain in older Caucasians, not related to moles
-acral lentiginous melanoma: found in all skin types in the sole of the feet, palms of the hands, undersides of the fingers or finger nails or toe nails

Prevention is better than cure. We should avoid sunburn and generally reduce exposure to ultraviolet radiation by staying out of the midday sun, wearing protective clothing, and seeking shade and applying sunscreen.

Now, that cannot be too difficult!

Example of recurrent melanoma:
Example of recurrent melanoma.

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Enlarged lymph glands should not be ignored.

Enlarged Lymph Glands in the Neck Due to Cancer of the Tongue
Enlarged Lymph Glands in the Neck Due to Cancer of the Tongue

During the flu season it is not uncommon to find people complaining of enlarged glands in the neck. The glands are usually enlarged due to viral infection. There is a reason why we are born with hundreds of lymph glands in our body. So, let us find out why normally we cannot feel them but in disease we can find them.

The lymph glands are also known as lymph nodes. A lymph node acts as a filter and is part of the lymphatic system. Tissues in the body release fluid called lymph. Lymph is transported through the lymphatic system, is filtered through the lymph nodes and the filtered fluid is then transported to the blood to maintain fluid balance.

Lymph nodes contain lymphocytes which destroy bacteria and viruses. When the body is fighting infection the lymph nodes produce more lymphocytes. The activity in the lymph node is increased and the node gets enlarged.

Our body has approximately 500-600 lymph nodes. They are found in the underarms, groin, neck, chest, and abdomen. They vary in size from few millimeters to couple of centimeters. Normally, they are not palpable on physical examination unless they enlarge due to infection or tumour.

Enlarged lymph nodes due to viral infection are “reactive” in nature and are usually small, firm and non-tender and they may not go away for weeks to months. Enlarged nodes due to bacterial infection are usually tender and more than a centimeter large. The most common site is the neck. These nodes get enlarged due to infection in the mouth, throat or the scalp. This may be associated with fever.

There are many other causes of lymph node enlargement such as: eczema, mono, tuberculosis, cat scratch disease, cancer (Hodgkin’s disease, non-Hodgkin’s disease, leukemia or metastatic cancer from other site).

A good history and physical examination is important in a patient presenting with persistent enlarged lymph node. This may give us a clue regarding the origin of the problem. Clinically, we may find that there is more than one area of enlarged nodes. The liver and spleen may be enlarged as well as they are part of the lymphatic system.

Patient is initially treated with 10 days of antibiotics. If the node does not respond to antibiotics then further investigations should be done to check for other causes of enlargement.

Blood tests, ultrasound and chest x-ray may give us more information. Finally, CAT scan, fine needle aspiration biopsy or open biopsy will be required to get to the bottom of the problem.

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Safety of calcium supplements questioned – how much is enough?

One thing is beyond dispute – whatever the age, we all need calcium to make our teeth and bones strong. Calcium is also required to make our muscles and nerves function. Calcium is also a necessary factor for blood clotting.

Although these facts are well known, many people continue to be deficient in their calcium intake and hence in their body’s total calcium requirement. This leads to bad teeth and osteoporosis, bone fractures and its nasty complications.

On the other hand, studies have shown that too much calcium is not good for your health. But how much is enough? There is no agreement on that.

-In Britain, women over 50 are urged to consume 700 milligrams a day.
-In Scandinavia the level is set at 800 mg.
-In the United States and Canada it’s 1,200 mg.

-In Australia and New Zealand top the list with 1,300 mg.

A Swedish study published in the British Medical Journal found that women who consumed less than 700 mg of calcium a day had a higher risk of fractures than those who took in larger amounts. But an intake of more than 700 mg per day didn’t seem to provide any additional protection. The results suggest that there are no further benefits to taking more than 700 mg. of calcium every day.

Some studies have suggested that taking calcium supplements (but not calcium from food) may increase a woman’s chances of developing heart disease. Other studies have suggest that calcium may play an important role in the development of prostate cancer but evidence also shows calcium may lower the risk of colon cancer and age-related thinning of the bones.

Men are also prone to getting osteoporosis. In women, bone loss begins before menopause and is accelerated in old age. So prevention is better than cure.

One glass of milk contains 300 mg of calcium. About 175 ml of plain yogurt and 42 grams of cheese each contain about 300 mg of calcium. You can get enough calcium on a daily basis just by drinking milk and enjoying natural yogurt and cheese.

And don’t forget your vitamin D 1000 to 2000 IU per day especially in winter months. Vitamin D has an important role in preventing prostate cancer and other cancers.

A report published in the Journal of the American Geriatrics Society says vitamin D, taken in a high dose, may help prevent falls in the elderly. The study shows that nursing home residents who took a daily dose of 800 international units (IU) of vitamin D for five months were less likely to fall than those who took either lower doses or no vitamin D.

Another paper reviewed 29 observational studies and concluded that in North America, a projected 50 per cent reduction in colon and breast cancer incidence would require a universal intake of 2,000 to 3,500 IU per day of vitamin D.

A third report came out in the Archives of Internal Medicine. This review paper analyzed the results of 18 vitamin D studies says that taking vitamin D supplements may help people live longer. But it’s not yet clear exactly how vitamin D does that. But it appears to be a life extender.

Don’t be confused now. Eat a healthy balanced diet, take vitamin D and do regular exercise. Talk to your doctor to find out what is the best dose of calcium and vitamin D for you. Then sit on a recliner and enjoy a cold or hot glass of milk. Sounds like a good idea to me.

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In this rainy season, have you checked your house for mold?

Quite often we talk about mold when we see a growth of minute fungi forming on vegetable or animal matter, commonly as a fluffy coating, and associated with decay or dampness. Sometimes you open the fridge and find mold spread over bread and cheese. Mold can be found on books and files as well.

Molds can be found in other places in the house. Painted walls and certain types of wallpapers can become overgrown by certain fungi, particularly in humid places such as showers.

You have just invested your life’s savings in a dream home. You have inspected the house thoroughly looking for possible problems. But you forget to check for mold.

It is said that virtually all buildings contain molds, but some are moldier than others. Molds love the interior of the buildings where they can adapt to dry conditions but molds cannot survive without some moisture. You wonder where the moisture comes from. The source could be a leaky basement, a dripping pipe or a roof in need of repair.

Usually it is hard to know if your house is moldy until somebody in the house complains of persistent allergies, headache, nausea or respiratory symptoms. A moldy building can be a serious health hazard.

This brings us to the subject of fungus. Mold is a kind of fungus. Fungi are all around us. Not all fungi are harmful. The American Heritage Science Dictionary defines fungi as any of a wide variety of organisms that reproduce by spores, including the mushrooms, molds, yeasts, and mildews. Spores can remain dormant for years.

Fungi can live in a wide variety of environments, fungal spores can survive extreme temperatures and fungi exist in over 100,000 species, nearly all of which live on land They can be extremely destructive, feeding on almost any kind of material and causing food spoilage and many plant diseases.

The fungus grows best in moist, damp, dark places with poor ventilation and on skin that is irritated, weakened or continuously moist. Most of the fungi are very helpful in the natural environment and only a few cause diseases in humans, plants and animals.

Candida is yeast like fungus which may cause athlete’s foot, vaginitis, thrush, or other infections. It can thrive in moist skin fold areas under the breasts, overhanging abdominal adipose tissues, groins, between fingers and toes, in the armpits and in the anus. Some of the fungi are dermatophytes which cause parasitic infections of the skin, hair, nails and adjacent mucous membranes.

Systemic fungal infections occur when spores are touched or inhaled by patients with chronic illnesses with poor immunity. Patients with systemic infection may have no symptoms or may have flu-like symptoms – coughing, fever, chest pain, chills, weight loss and difficulty with breathing.

Certain fungi, such as mushrooms, can produce poisonous toxins that may prove fatal if ingested.

Skin infection with fungus can be treated with antifungal skin ointment. Systemic fungal infection requires oral antifungal pills. Fungal infection can be prevented by keeping our body and the environment clean and healthy.

And make sure your leaky roof or foundation is fixed.

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