Karen Dente

NEW YORK — The incidence of regression is higher in malignant melanoma than in other neoplasms, Dr. Hideko Kamino said at a dermatology conference sponsored by New York University.

Regression is more common in men, in thin melanomas less than 1.5 mm, and in lesions on the trunk, said Dr. Kamino of the departments of dermatology and pathology at New York University.

Regressing melanomas present with a history of a changing lesion that is typically a patch of plaque of variegated brown, black, red, blue, gray, or white. Blue, black, or gray areas usually mean a proliferation of small blood vessels, a histopathologic sign of late regression. An inflammatory infiltrate is generally seen early in regression.

“The incidence of regression in melanoma depends on whether it is partial, focal, or complex,” she said. Partial regression is seen in 10%–35% of melanomas, complete regression in about 5%. Histologic regression of less than 1.5 mm is most common, seen in 46% of melanomas. Regression of 1.5 to 3 mm occurs in about 32% of lesions.

Regression may be induced by treatment with interleukin-2, interferon-α, vaccines, and imiquimod, she pointed out.

NEW YORK — The incidence of regression is higher in malignant melanoma than in other neoplasms, Dr. Hideko Kamino said at a dermatology conference sponsored by New York University.

Regression is more common in men, in thin melanomas less than 1.5 mm, and in lesions on the trunk, said Dr. Kamino of the departments of dermatology and pathology at New York University.

Regressing melanomas present with a history of a changing lesion that is typically a patch of plaque of variegated brown, black, red, blue, gray, or white. Blue, black, or gray areas usually mean a proliferation of small blood vessels, a histopathologic sign of late regression. An inflammatory infiltrate is generally seen early in regression.

“The incidence of regression in melanoma depends on whether it is partial, focal, or complex,” she said. Partial regression is seen in 10%–35% of melanomas, complete regression in about 5%. Histologic regression of less than 1.5 mm is most common, seen in 46% of melanomas. Regression of 1.5 to 3 mm occurs in about 32% of lesions.

Regression may be induced by treatment with interleukin-2, interferon-α, vaccines, and imiquimod, she pointed out.

NEW YORK — The incidence of regression is higher in malignant melanoma than in other neoplasms, Dr. Hideko Kamino said at a dermatology conference sponsored by New York University.

Regression is more common in men, in thin melanomas less than 1.5 mm, and in lesions on the trunk, said Dr. Kamino of the departments of dermatology and pathology at New York University.

Regressing melanomas present with a history of a changing lesion that is typically a patch of plaque of variegated brown, black, red, blue, gray, or white. Blue, black, or gray areas usually mean a proliferation of small blood vessels, a histopathologic sign of late regression. An inflammatory infiltrate is generally seen early in regression.

“The incidence of regression in melanoma depends on whether it is partial, focal, or complex,” she said. Partial regression is seen in 10%–35% of melanomas, complete regression in about 5%. Histologic regression of less than 1.5 mm is most common, seen in 46% of melanomas. Regression of 1.5 to 3 mm occurs in about 32% of lesions.

Regression may be induced by treatment with interleukin-2, interferon-α, vaccines, and imiquimod, she pointed out.

NEW YORK – Major life events and other stressors cannot be definitively associated with the initiation or progression of cancer, according to Bert Garssen, Ph.D., of the Centre for Psycho-Oncology at the Helen Dowling Institute in Utrecht, the Netherlands.

In a series of long-term follow-up studies reviewed at a dermatology symposium sponsored by Cornell University, Dr. Garssen reviewed the medical literature on the role of stress in the initiation and progression of cancer. Included in the review were a total of 77 “truly prospective studies, restricted to studies with adequate design,” he said. About 34 studies included breast cancer patients only, while 29 examined cancer initiation and 48 cancer progression.

Stress was defined as having experienced serious life events, bereavement, and negative emotional states, including anxiety, distress, and depression, having (or having had) a psychiatric diagnosis–in particular a depressive disorder–or exhibiting a tendency toward helplessness.

Breast cancer was the only cancer in which stress was associated with poorer outcomes, seen in 5 of 6 studies (83%) of patients with metastatic disease and in 9 of 14 studies (64%) of patients with localized breast cancers. One hypothesis is that stress may influence hormone levels and could play a role in hormone-sensitive tumors, Dr. Garssen noted.

He also had performed an earlier review of 70 longitudinal studies published between 1978 and 2002 on the role of psychological factors on cancer initiation and progression, and established that the majority of studies found a relationship between psychological factors and disease, but rarely for the same factor (Clin. Psychol. Rev. 2004;24:315–38).

In most prospective studies of psychological factors in disease, the design does not resolve whether psychological factors influence disease or whether the disease influences psychological well-being. “The illness process may have had a direct influence on the psychological function,” he said, and “the assumption patients have about the diagnosis” before the actual diagnosis is made, may play a role.

A review of five studies found no evidence that major life events, such as partner loss or child loss, play a role in cancer progression. It did show, however, that the loss of a mother in childhood increased the chance of breast cancer.

This was not found to be true with the loss of a father during the same time period.

Helplessness also was not associated with disease outcomes in 8 of 12 studies, Dr. Garssen said.

NEW YORK – Major life events and other stressors cannot be definitively associated with the initiation or progression of cancer, according to Bert Garssen, Ph.D., of the Centre for Psycho-Oncology at the Helen Dowling Institute in Utrecht, the Netherlands.

In a series of long-term follow-up studies reviewed at a dermatology symposium sponsored by Cornell University, Dr. Garssen reviewed the medical literature on the role of stress in the initiation and progression of cancer. Included in the review were a total of 77 “truly prospective studies, restricted to studies with adequate design,” he said. About 34 studies included breast cancer patients only, while 29 examined cancer initiation and 48 cancer progression.

Stress was defined as having experienced serious life events, bereavement, and negative emotional states, including anxiety, distress, and depression, having (or having had) a psychiatric diagnosis–in particular a depressive disorder–or exhibiting a tendency toward helplessness.

Breast cancer was the only cancer in which stress was associated with poorer outcomes, seen in 5 of 6 studies (83%) of patients with metastatic disease and in 9 of 14 studies (64%) of patients with localized breast cancers. One hypothesis is that stress may influence hormone levels and could play a role in hormone-sensitive tumors, Dr. Garssen noted.

He also had performed an earlier review of 70 longitudinal studies published between 1978 and 2002 on the role of psychological factors on cancer initiation and progression, and established that the majority of studies found a relationship between psychological factors and disease, but rarely for the same factor (Clin. Psychol. Rev. 2004;24:315–38).

In most prospective studies of psychological factors in disease, the design does not resolve whether psychological factors influence disease or whether the disease influences psychological well-being. “The illness process may have had a direct influence on the psychological function,” he said, and “the assumption patients have about the diagnosis” before the actual diagnosis is made, may play a role.

A review of five studies found no evidence that major life events, such as partner loss or child loss, play a role in cancer progression. It did show, however, that the loss of a mother in childhood increased the chance of breast cancer.

This was not found to be true with the loss of a father during the same time period.

Helplessness also was not associated with disease outcomes in 8 of 12 studies, Dr. Garssen said.

NEW YORK – Major life events and other stressors cannot be definitively associated with the initiation or progression of cancer, according to Bert Garssen, Ph.D., of the Centre for Psycho-Oncology at the Helen Dowling Institute in Utrecht, the Netherlands.

In a series of long-term follow-up studies reviewed at a dermatology symposium sponsored by Cornell University, Dr. Garssen reviewed the medical literature on the role of stress in the initiation and progression of cancer. Included in the review were a total of 77 “truly prospective studies, restricted to studies with adequate design,” he said. About 34 studies included breast cancer patients only, while 29 examined cancer initiation and 48 cancer progression.

Stress was defined as having experienced serious life events, bereavement, and negative emotional states, including anxiety, distress, and depression, having (or having had) a psychiatric diagnosis–in particular a depressive disorder–or exhibiting a tendency toward helplessness.

Breast cancer was the only cancer in which stress was associated with poorer outcomes, seen in 5 of 6 studies (83%) of patients with metastatic disease and in 9 of 14 studies (64%) of patients with localized breast cancers. One hypothesis is that stress may influence hormone levels and could play a role in hormone-sensitive tumors, Dr. Garssen noted.

He also had performed an earlier review of 70 longitudinal studies published between 1978 and 2002 on the role of psychological factors on cancer initiation and progression, and established that the majority of studies found a relationship between psychological factors and disease, but rarely for the same factor (Clin. Psychol. Rev. 2004;24:315–38).

In most prospective studies of psychological factors in disease, the design does not resolve whether psychological factors influence disease or whether the disease influences psychological well-being. “The illness process may have had a direct influence on the psychological function,” he said, and “the assumption patients have about the diagnosis” before the actual diagnosis is made, may play a role.

A review of five studies found no evidence that major life events, such as partner loss or child loss, play a role in cancer progression. It did show, however, that the loss of a mother in childhood increased the chance of breast cancer.

This was not found to be true with the loss of a father during the same time period.

Helplessness also was not associated with disease outcomes in 8 of 12 studies, Dr. Garssen said.

NEW YORK — Plastic surgeons' approach to nevi in challenging anatomical locations may differ from that of dermatologists, said Dr. Barry Zide at a dermatology conference sponsored by New York University.

"When I look at nevi, I have questions that have to be asked: Can it be shaved? What residual or abnormal pigment will occur, and why? How many aesthetic units are involved? What ancillary methods can be used? How many steps will it take?" said Dr. Zide, professor of plastic surgery at New York University, New York.

One thing to avoid is scab formation after shaving. This can be prevented by not allowing the shaved area to dry out. "Patients have to keep [an adhesive bandage] on for 7–10 days postop," Dr. Zide said.

"A bulky nevus of the nose has a minimal tendency to be malignant, so you can leave some nevus without taking the whole thing off," said Dr. Zide, referring to a case in which he did not have to biopsy the whole lesion but worked with shaving, abrasion, and electrolysis to manage the lesion. The advantage to this approach is that it leaves no reconstructive defect.

For dark lesions located above the tip of the nose, skin grafting is an option. "It is important to think in terms of aesthetic units," he said, adding, "The best place for a graft of the nose is the forehead. It has good color." A patch and edges are not perfect, so sanding the units post dermabrasion over a wide area that is not just limited to the actual skin graft is important. "Think big on dermabrasion, even though the graft can be small."

When confronted with a big nevus in a very young child, remember that in babies younger than 4 months old, there is a lot of skin to work with because their skin on the head hasn't yet firmly bound to the scalp. "You can take a lot of skin and do a straight excision in some cases, or a W-plasty," Dr. Zide explained.

Sometimes multiple steps are needed. Patients should always be informed of and prepared for the biopsy of a nevus to entail several steps.

NEW YORK — Plastic surgeons' approach to nevi in challenging anatomical locations may differ from that of dermatologists, said Dr. Barry Zide at a dermatology conference sponsored by New York University.

"When I look at nevi, I have questions that have to be asked: Can it be shaved? What residual or abnormal pigment will occur, and why? How many aesthetic units are involved? What ancillary methods can be used? How many steps will it take?" said Dr. Zide, professor of plastic surgery at New York University, New York.

One thing to avoid is scab formation after shaving. This can be prevented by not allowing the shaved area to dry out. "Patients have to keep [an adhesive bandage] on for 7–10 days postop," Dr. Zide said.

"A bulky nevus of the nose has a minimal tendency to be malignant, so you can leave some nevus without taking the whole thing off," said Dr. Zide, referring to a case in which he did not have to biopsy the whole lesion but worked with shaving, abrasion, and electrolysis to manage the lesion. The advantage to this approach is that it leaves no reconstructive defect.

For dark lesions located above the tip of the nose, skin grafting is an option. "It is important to think in terms of aesthetic units," he said, adding, "The best place for a graft of the nose is the forehead. It has good color." A patch and edges are not perfect, so sanding the units post dermabrasion over a wide area that is not just limited to the actual skin graft is important. "Think big on dermabrasion, even though the graft can be small."

When confronted with a big nevus in a very young child, remember that in babies younger than 4 months old, there is a lot of skin to work with because their skin on the head hasn't yet firmly bound to the scalp. "You can take a lot of skin and do a straight excision in some cases, or a W-plasty," Dr. Zide explained.

Sometimes multiple steps are needed. Patients should always be informed of and prepared for the biopsy of a nevus to entail several steps.

NEW YORK — Plastic surgeons' approach to nevi in challenging anatomical locations may differ from that of dermatologists, said Dr. Barry Zide at a dermatology conference sponsored by New York University.

"When I look at nevi, I have questions that have to be asked: Can it be shaved? What residual or abnormal pigment will occur, and why? How many aesthetic units are involved? What ancillary methods can be used? How many steps will it take?" said Dr. Zide, professor of plastic surgery at New York University, New York.

One thing to avoid is scab formation after shaving. This can be prevented by not allowing the shaved area to dry out. "Patients have to keep [an adhesive bandage] on for 7–10 days postop," Dr. Zide said.

"A bulky nevus of the nose has a minimal tendency to be malignant, so you can leave some nevus without taking the whole thing off," said Dr. Zide, referring to a case in which he did not have to biopsy the whole lesion but worked with shaving, abrasion, and electrolysis to manage the lesion. The advantage to this approach is that it leaves no reconstructive defect.

For dark lesions located above the tip of the nose, skin grafting is an option. "It is important to think in terms of aesthetic units," he said, adding, "The best place for a graft of the nose is the forehead. It has good color." A patch and edges are not perfect, so sanding the units post dermabrasion over a wide area that is not just limited to the actual skin graft is important. "Think big on dermabrasion, even though the graft can be small."

When confronted with a big nevus in a very young child, remember that in babies younger than 4 months old, there is a lot of skin to work with because their skin on the head hasn't yet firmly bound to the scalp. "You can take a lot of skin and do a straight excision in some cases, or a W-plasty," Dr. Zide explained.

Sometimes multiple steps are needed. Patients should always be informed of and prepared for the biopsy of a nevus to entail several steps.

NEW YORK – There is mounting evidence that stress and the way in which patients with psoriasis view themselves or perceive themselves to be seen affects the way that they respond to treatment, Dr. Christopher Griffiths said at a dermatology symposium sponsored by Cornell University.

“While the exact etiology of psoriasis remains unknown, there is a strong environmental component to the disease, including stress, especially in the genetically predisposed with the HLA-Cw6 gene,” said Dr. Griffiths of the dermatology center at Hope Hospital, University of Manchester (England), the largest center for psoriasis research and treatment in the world.

Psoriasis occurs in about 2% of the population. Whether stress causes psoriasis or psoriasis is the origin of stress is still a point of contention. Studies have shown that psoriasis ranks just ahead of chronic lung disease and depression when it comes to the impact reported on the daily lives of patients, with 46% reporting an impact on their daily lives, versus 44% and 35% with chronic lung disease and depression, respectively. Approximately 60% of patients with psoriasis report that stressful life events may either trigger or exacerbate their condition, Dr. Griffiths said.

With 53% of patients strongly affected by how they view themselves and 28% by how they see themselves viewed by others, “psoriasis strongly affects how patients see themselves and how they think others see them,” he said.

“Patients with psoriasis are constantly looking for environmental cues which might be signs of how others are viewing them,” Dr. Griffiths noted.

A study using the Penn State Worry Questionnaire to measure whether worry affected 88 patients' (57 males, 31 females) response to PUVA therapy showed a correlation between worry and treatment efficacy. Patients who were high or pathologic worriers were less likely to show a response to PUVA therapy than were patients in the normal or low worry categories. “Those patients who did respond took twice as long to respond to PUVA treatment if they were higher on the worry scale,” Dr. Griffiths said.

The average age of patients in the study was 43 years.

Dr. Griffiths also reported that managing psoriasis symptoms with adjuncts such as behavioral therapy measurably enhances response to standard therapy.

Psoriasis patients always look for environmental cues that might be signs of how others are viewing them. DR. GRIFFITHS

NEW YORK – There is mounting evidence that stress and the way in which patients with psoriasis view themselves or perceive themselves to be seen affects the way that they respond to treatment, Dr. Christopher Griffiths said at a dermatology symposium sponsored by Cornell University.

“While the exact etiology of psoriasis remains unknown, there is a strong environmental component to the disease, including stress, especially in the genetically predisposed with the HLA-Cw6 gene,” said Dr. Griffiths of the dermatology center at Hope Hospital, University of Manchester (England), the largest center for psoriasis research and treatment in the world.

Psoriasis occurs in about 2% of the population. Whether stress causes psoriasis or psoriasis is the origin of stress is still a point of contention. Studies have shown that psoriasis ranks just ahead of chronic lung disease and depression when it comes to the impact reported on the daily lives of patients, with 46% reporting an impact on their daily lives, versus 44% and 35% with chronic lung disease and depression, respectively. Approximately 60% of patients with psoriasis report that stressful life events may either trigger or exacerbate their condition, Dr. Griffiths said.

With 53% of patients strongly affected by how they view themselves and 28% by how they see themselves viewed by others, “psoriasis strongly affects how patients see themselves and how they think others see them,” he said.

“Patients with psoriasis are constantly looking for environmental cues which might be signs of how others are viewing them,” Dr. Griffiths noted.

A study using the Penn State Worry Questionnaire to measure whether worry affected 88 patients' (57 males, 31 females) response to PUVA therapy showed a correlation between worry and treatment efficacy. Patients who were high or pathologic worriers were less likely to show a response to PUVA therapy than were patients in the normal or low worry categories. “Those patients who did respond took twice as long to respond to PUVA treatment if they were higher on the worry scale,” Dr. Griffiths said.

The average age of patients in the study was 43 years.

Dr. Griffiths also reported that managing psoriasis symptoms with adjuncts such as behavioral therapy measurably enhances response to standard therapy.

Psoriasis patients always look for environmental cues that might be signs of how others are viewing them. DR. GRIFFITHS

NEW YORK – There is mounting evidence that stress and the way in which patients with psoriasis view themselves or perceive themselves to be seen affects the way that they respond to treatment, Dr. Christopher Griffiths said at a dermatology symposium sponsored by Cornell University.

“While the exact etiology of psoriasis remains unknown, there is a strong environmental component to the disease, including stress, especially in the genetically predisposed with the HLA-Cw6 gene,” said Dr. Griffiths of the dermatology center at Hope Hospital, University of Manchester (England), the largest center for psoriasis research and treatment in the world.

Psoriasis occurs in about 2% of the population. Whether stress causes psoriasis or psoriasis is the origin of stress is still a point of contention. Studies have shown that psoriasis ranks just ahead of chronic lung disease and depression when it comes to the impact reported on the daily lives of patients, with 46% reporting an impact on their daily lives, versus 44% and 35% with chronic lung disease and depression, respectively. Approximately 60% of patients with psoriasis report that stressful life events may either trigger or exacerbate their condition, Dr. Griffiths said.

With 53% of patients strongly affected by how they view themselves and 28% by how they see themselves viewed by others, “psoriasis strongly affects how patients see themselves and how they think others see them,” he said.

“Patients with psoriasis are constantly looking for environmental cues which might be signs of how others are viewing them,” Dr. Griffiths noted.

A study using the Penn State Worry Questionnaire to measure whether worry affected 88 patients' (57 males, 31 females) response to PUVA therapy showed a correlation between worry and treatment efficacy. Patients who were high or pathologic worriers were less likely to show a response to PUVA therapy than were patients in the normal or low worry categories. “Those patients who did respond took twice as long to respond to PUVA treatment if they were higher on the worry scale,” Dr. Griffiths said.

The average age of patients in the study was 43 years.

Dr. Griffiths also reported that managing psoriasis symptoms with adjuncts such as behavioral therapy measurably enhances response to standard therapy.

Psoriasis patients always look for environmental cues that might be signs of how others are viewing them. DR. GRIFFITHS