ACCURATE PATHOLOGY IS CRITICAL

Dermatopathologists highly accurate in classifying pigmented skin lesions

Board-certified or fellowship-trained dermatopathologists are less likely than general pathologists to misclassify biopsies of melanocytic skin lesions, according to a study in JAMA Network Open. "Our results show having a second opinion by an expert with subspecialty training provides value in improving the accuracy of the diagnosis, which is imperative to help guide patients to the most effective treatments," said study co-leader Joann Elmore.

BE EDUCATED - ANY DOCTOR CAN CLAIM TO BE A COSMETIC SURGEON

A new RealSelf survey conducted online by The Harris Poll reveals that 59% of women in the US do not know there is a difference between a cosmetic surgeon and a plastic surgeon. Furthermore, more than eight in 10 women (84%) in the US are unaware that medical professionals do not have to be board certified in plastic surgery to perform surgical cosmetic procedures such as rhinoplasty or breast augmentation.

The report also reveals that a growing number of women are seeking cosmetic treatments for the first time. More than one in four women in the US (26%) are currently considering a cosmetic procedure, and nearly three-fourths of those women (73%) have never had one in the past. Interest is higher among young adults, with females ages 18-34 nearly two times more likely than those 35 and older to be considering a cosmetic procedure (37% vs. 21%).

STAY CALM, DON'T PANIC

Plastic surgeons warn not to overreact to breast implant recall

Textured breast implants like those recalled by Allergan are still considered safe medical devices and the FDA has emphasized that if you have textured implants, you  do not need to have them removed in the absence of symptoms of implant-associated anaplastic large cell lymphoma (late swelling or a palpable nodule). The risk for BIA-ALCL is low, and women should be alert for symptoms but should not be afraid.

 

Allergan textured implants have a 6 times higher risk of developing Anaplastic Large Cell Lymphoma. Mentor and Siltex texturing is different and runs a very small risk of this problem.

 

We are also receiving calls about implant associated health issues.  We went through this same issue in the early 1990's and the FDA after a very intense clinical study of over 50,0000 patients came to the conclusion that breast implants are as safe as any medical device and there is not an increased risk of health problems such as auto-immune disease, chronic fatigue syndrome, arthritis, etc. in patients that have breast implants.

 

My advice to patients - if you think your implants are causing health issues, take them out.  If it makes you feel better after removal, that is great.

 

There is too much hysteria and inaccurate information (especially on these internet web sites) about this problem - I saw a news report recently with a patient testimonial - she was having all sorts of health problems and after taking her implants out, she felt better the next day.  Really???  If the patient had a true disease related to her breast implants, this is not going to reverse itself 24 hours after taking the breast implants out.

 

Stay Calm, Don't Panic

NICOTINE CREATES PROBLEMS

Smoking may increase risk of skin cancer surgery complications, study indicates

Reuters (7/19, Rapaport) reported researchers found that “complications after skin cancer surgery may be more common in smokers and former smokers.” The findings were published in JAMA Facial Plastic Surgery.

CHEAP IS NOT ALWAYS GOOD

Another US patient dies after plastic surgery in Dominican Republic A New York woman who went to the Dominican Republic for liposuction after US doctors told her she should lose weight before getting body contouring died during the procedure, reportedly from a fatty tissue embolism. Plastic surgeon Henry Spinelli said safe options exist in Europe and South America, and "to indiscriminately choose some place on the basis of finances is a grave mistake."

Truth in Advertising

Health Quality & Advocacy

Va. plastic surgeons push for "truth in advertising" resolution Physicians in Virginia and elsewhere in the US who are not board certified in plastic or aesthetic surgery can take short courses to learn how to perform body contouring procedures, which may put patients at risk, says plastic surgeon Neil Zemmel. The Virginia Society of Plastic Surgery is urging state legislators to approve a resolution requiring physicians to inform patients about which board certifications they hold.   In Oklahoma, I  have been pushing for the same type of legislation to better inform the public.  Although the bill has been written and has been in the hands of the legislators for the last couple of years, they have failed to push this bill through the proper channels so it can be brought before the House and Senate for approval.

VYLEESI

FDA approves new medication intended to enhance sexual desire in women

The Washington Post (6/21, Cha, McGinley) reported that on Friday, the FDA “approved sales of a new drug intended to enhance sexual desire in women.” The Post added, “Marketed as Vyleesi, also known as bremelanotide, the medication is a shot that comes in a push pen device that can be self-administered as needed for premenopausal women who experience marked distress as a result of low sexual desire.”

The AP (6/21, Perrone) reported that “the approval was based on women’s responses to questionnaires that showed increases in sexual desire and decreases in stress related to sex,” although “the women didn’t report having more sex, the original goal for the drug.”

PRICE TRANSPARENCY

Health Quality & Advocacy

Trump signs executive order on health care price transparency President Donald Trump signed an executive order calling for the creation of a rule to require disclosure of negotiated prices of common tests and services and a proposal to require that patients be informed of estimated out-of-pocket costs before treatment. AHIP President and CEO Matt Eyles pushed back against the order, arguing that public disclosure of "competitively negotiated, proprietary rates will reduce competition and push prices higher -- not lower -- for consumers, patients, and taxpayers."

HPV VACCINE

CDC panel says people through age 45 could benefit from getting HPV vaccine

The Washington Post (6/26, Bever) reports at a two-day meeting of the CDC’s Advisory Committee on Immunization Practices (ACIP), a “public health advisory panel said Wednesday that people through age 45 could benefit from getting an HPV vaccine and should discuss the possibility with their doctors.” According to the Post, “one committee member said although most people in that age group do not need the vaccine, it may be beneficial for a small number,” while opponents of the change “cited concerns about potential disparities in access to the vaccine, the global vaccine supply and a potential decline in immunization rates among teenagers and young adults.”

The AP (6/26, Stobbe) reports “the Advisory Committee on Immunization Practices’ vote in Atlanta raises the recommended vaccination age for men from 21 to 26, making it the same as the existing recommendation for women.”

YOUR TEENAGE CHILDREN NEED CLOSE ATTENTION

Suicide rates increasing among U.S. teens, study indicates

Reuters (6/18, Carroll) reports that since 2007, “suicide rates have been climbing among U.S. teens, with an especially pronounced increase in boys recently,” researchers concluded after examining data from “the Centers for Disease Control and Prevention’s Underlying Cause of Death database.” The study’s lead author “hopes the study will alert parents and other relatives to the increasing suicide rates so they will notice changes in teens and young adults that might suggest a risk for suicide.” The findings were published June 18 in a research letter in JAMA.

According to CNN (6/18, Howard), “overall in 2017, there were 6,241 suicides among young people aged 15 to 24, of whom 5,016 were young men and 1,225 were young women, the researchers found.” The study, however, “had some limitations, including that the causes of death in the data were based on death certificates, which can be subject to error, or it could suggest that the observed increase in suicide deaths may reflect more accurate reporting in certificates.” In addition, investigators “did not examine factors behind the increase in suicide rates.”

CIRCULATING TUMOR CELLS (CTC)

Scientists have created a laser-based platform that can quickly and noninvasively screen large quantities of blood in patients with melanoma to detect circulating tumor cells (CTCs) – a precursor to deadly metastases.
The new system accurately sniffed out hard-to-detect CTCs in 27 of 28 patients with the cancer in as little as 10 seconds and was 1,000 times more sensitive than existing assays (detecting one CTC per liter of blood). Although more work is needed, the test could help identify patients at risk of metastasis and guide the use of laser therapies to kill melanoma cells.
Researchers have attempted to assess CTCs to determine the risk of metastasis in patients, but existing assays can only examine small amounts of blood, which sometimes do not capture any CTCs. Seeking a solution, Ekaterina Galanzha and colleagues created a system called the Cytophone that uses laser pulses and focused ultrasound to noninvasively peer under the skin of patients with melanoma, revealing pigmented CTCs that pass through veins in the arm, a media release from American Association for the Advancement of Science explains.
The study was published recently in Science Translational Medicine.
Galanzha et al applied their technology to 28 light-skinned patients with melanoma and 19 healthy volunteers and found that it identified CTCs in 27 (96%) of the patients between 10 seconds and 60 minutes without generating false positives in the controls.
Importantly, the system’s laser could destroy the detected CTCs, resulting in a large drop in CTC numbers. It also uncovered circulating blood clots – the second leading cause of death in cancer patients.
The Cytophone was able to account for other variables such as patient skin pigmentation and movement, but future studies should investigate and expand on the range of skin tones for which the technology could be used, the release continues.
[Source(s): American Association for the Advancement of Science, EurekAlert]

 

STIMULATING THE IMMUNE SYSTEM TO TREAT CANCER

Pembrolizumab approved for first-line treatment of head and neck squamous cell carcinoma

Reuters (6/11, Babu) reports that “Merck & Co Inc said on Tuesday its blockbuster cancer drug Keytruda [pembrolizumab] won approval from the” FDA “to treat a type of head and neck cancer.” The medication “was approved for use as a monotherapy, as well as in combination with a common chemotherapy regimen, to treat previously untreated patients with head and neck squamous cell carcinoma, Merck said.”

 

BE CAREFUL

WHO: Over one million people acquire STIs daily

Reuters (6/6, Kelland) reports the World Health Organization released data on Thursday indicating “more than a million people every day worldwide catch a sexually transmitted infection (STI), with rates of chlamydia, gonorrhoea, trichomoniasis and syphilis the most worrying.” The WHO “report, based on 2016 global data which are the latest available, showed that among men and women aged between 15 and 49 there were 127 million new cases of chlamydia in 2016, 87 million of gonorrhoea, 6.3 million of syphilis and 156 million of trichomoniasis.”

CELLULITE

Cellulite is simply subcutaneous fat enmeshed in connective tissue, and women are more prone to the harmless condition as they age and estrogen levels decline. A review of 67 studies found no effective long-term treatment, although weight loss can improve the appearance of cellulite.  Acoustic wave therapy and treatments such as laser therapy that sever connective tissue bands have been shown to yield only short-term improvements.

MONITOR FOR MELANOMA IN ALL AREAS OF THE BODY

Spending time in the sun without protection increases the risk of melanoma, but the potentially deadly skin cancer can occur even on sites with minimal sun exposure, doctors warn.
Melanoma accounts for only about 1% of skin cancers but causes the majority of skin cancer deaths.
Writing in the medical journal CMAJ, two dermatology experts highlight important things to know about the most dangerous form of skin cancer.
“Melanomas can occur anywhere on the body, not only in areas that get a lot of sun,” Dr. Kucy Pon told Reuters Health by email. She said the most common site in men is the back, while for women it is the leg.
More than 90% of melanomas with the most common genetic characteristics are caused by too much ultraviolet radiation, either from the sun or from sun lamps like the kind used at tanning salons, Pon and co-author Robert Micieli say.
But for some melanomas on peripheral body parts like palms and soles, and on mucosal surfaces, sun exposure is not the primary cause, the authors note. In these cases, the cancer’s development may more closely match the chain of events that lead to non-skin-cancers.
Pon said the incidence of melanoma has been rising over the last 30 years, with an estimated 192,300 new cases expected in the U.S. in 2019.
The disease can affect anyone, regardless of skin color, Pon said.
Along with sun exposure, risk factors include advancing age, moles, many atypical looking moles and a family history of melanoma.
“The first sign of a melanoma is an unusual looking mole or freckle, said Pon, a dermatologist at Sunnybrook Health Sciences Center in Toronto.
But she and Micieli warn that in one of every 10 melanoma patients, the lesion may have no color at all and is difficult to diagnose.
“These unpigmented melanomas may be pinkish-looking, reddish, purple, normal skin color or essentially clear and colorless,” said Dr. Ronald Moy, a board-certified dermatologist in Beverly Hills, California and a spokesperson for the Skin Cancer Foundation.
Moy said in an email that these atypical melanomas can resemble other forms of skin cancers or, worse, may be mistaken for benign moles, scars or cysts, which may prove dangerous, since early detection of melanoma is critical.
Indeed, Pon and Micieli say any lesions suspected of being melanoma should be examined by a dermatologist, especially a lesion with so-called “ABCDE” features: Asymmetry, Border irregularity, Color variation, Diameter over 6 mm and Evolving or changing.
“Prevention and early detection are key,” agreed Dr. Emily Newsom, a dermatologist at UCLA Health in Los Angeles.
For prevention, dermatologists recommend frequent reapplication of at least 30 SPF broad-spectrum sunscreen as well as sun protective clothing and wide brimmed hats.
Finally, Pon and Micieli advise, when patients do have melanoma – particularly in cosmetically sensitive areas like face – the optimal way to excise it is with Mohs surgery, in which thin layers of the tumor are removed until only cancer-free tissue remains.
Researchers have made “tremendous breakthroughs” in learning about the genes involved in melanoma, said Dr. Jeffrey Farma, co-director of the Melanoma and Skin Cancer Program at Fox Chase Cancer Center in Philadelphia.
As a result, Farma added, great strides are being made in targeted therapies and immunotherapies for treating advanced melanoma and improving survival.

PRIOR INSURANCE AUTHORIZATIONS - ANOTHER OBSTACLE IN PROVIDING PATIENT CARE

Over 1 in 4 physicians say prior authorizations lead to serious adverse events, AMA survey finds

Fierce Healthcare (2/6, Finnegan) reports, “In a survey (pdf) by the American Medical Association” conducted online in December, “28% of 1,000 responding physicians said the prior authorization process required by health insurers for certain drugs, tests and treatments have led to serious or life-threatening adverse events for patients.” Physicians were specifically asked “if the prior authorization process ever affected care delivery and led to a serious adverse event, such as a death, hospitalization, disability or permanent bodily damage or other life-threatening event for a patient in their care.” In an announcement that released the result of the survey, AMA Chair Jack Resneck, Jr., M.D., said, “The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care.” Dr. Resneck added, “The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality healthcare they need.”

ANAPLASTIC LARGE CELL LYMPHOMA

FDA issues 2019 update on BIA-ALCL

The American Society of Plastic Surgeons (ASPS)  would like to make members aware of a Feb. 6  statement by the Food and Drug  Administration (FDA)  updating the number of adverse event  reports submitted to the agency related to  breast implant-associated anaplastic  large cell lymphoma (BIA-ALCL). The statement notes that as of September 2018,  the agency has received 660 total medical  device reports (MDR) regarding BIA-ALCL  cases in the United States – an increase of  246 new MDRs (59 percent) from the  previous year’s update. Acknowledging  that the nature of the MAUDE database’s  reporting system is susceptible to duplicate  reports, the agency’s analysis suggests  there are only 457 unique cases,  including nine deaths, of BIA-ALCL  reported (since 2010). The FDA  also notes that while the MDR  system is a valuable source of information,  it is a passive surveillance system with  limitations, including incomplete,  inaccurate, untimely, unverified or  biased data in the reports. The  incidence or prevalence of BIA-ALCL  cannot be determined from this reporting  system alone, due to potential under- reporting, duplicate reporting and lack  of information about the total number  of breast implants.

The FDA update calls  for no changes in recommendations  regarding breast implants.  For patients with breast implants,  the FDA states there is no need to  change routine medical care and  follow-up, and there is no need to  test asymptomatic patients. BIA-ALCL is a rare condition that occurs  most frequently in patients who have  breast implants with textured surfaces.  Patients should discuss with their  health-care provider the benefits  and risks of textured-surface  versus smooth-surface implants. .

BE CAREFUL WITH THOSE SCOOTERS AROUND TULSA

Electric scooters behind rash of visits to hospital EDs, study indicates

USA Today (1/25, Woodyard) reported, “Electric scooters are behind a rash of visits to hospital emergency” departments (EDs), researchers concluded. A study published online in JAMA Network Open revealed that “more electric scooter riders showed up with injuries in the emergency” departments “of two hospitals on Los Angeles’ scooter-heavy Westside than either bicyclists or pedestrians.” Among the patients admitted “some 40.2 percent” had “head injuries,” and 31.7 percent had fractures.

HOSPITAL ALLIANCES

Experts debate whether patients benefit when community hospitals join with major institutions

Kaiser Health News (1/28, Boodman) discusses “a much-touted but little understood collaboration in health care: alliances between community hospitals and some of the nation’s biggest and most respected institutions.” Experts warn that “affiliation with a famous name is not a guarantee of quality.” In some instances, “it’s purely branding and in other cases it’s a deep association,” one expert said. He added, “A key question is ‘how often does the community hospital interact with the flagship hospital? If it’s once a week, that’s one thing. If it’s almost never, that’s another.’” The article says it remains to be seen if patients benefit from these affiliations. The piece adds that in order to increase “their reach, flagship hospitals including Mayo, the Cleveland Clinic and Houston’s MD Anderson Cancer Center have signed affiliation agreements with smaller hospitals around the country.”

THE PRIMROSE CHRISTMAS BERRY - COULD IT BE USEFUL FOR MELANOMA TREATEMENT???

A molecule derived from a type of primrose may be a potent inhibitor of metastatic growth for a rare and aggressive cancer, as published in the journal Molecular Cancer Research.

Approximately 2000 adults are diagnosed with melanoma every year, in half of these cases the disease will metastasize to the liver and treatment options are scarce for these patients. Researchers from the Sidney Kimmel Cancer Center and the Icahn School of Medicine have found that a compound extracted from the Christmas berry primrose plant can stop cancer growth in preliminary tests; further testing could lead to new therapeutic options for those with melanoma.
Uveal melanoma accounts for 5% of all melanoma cases and is the most common eye cancer among adults forming in the melanocytes, although differing from skin melanoma both cancers are lethal. Radiation or surgery are the standard treatment for patients with primary UM that has not spread to other parts of the body, however metastases will occur in about half of these cases most often travelling to the liver; once spread patients often have only a year or so to live as no effective therapies have been developed.
FR900359 derived from Ardisia crenata of the primrose family was tested to investigate whether it may be able to fight the disease. FR900359 works by blocking a type of G protein that sits on a cell’s membrane called Gq which is a signalling molecule; a subset of the proteins are mutated in uveal melanoma turning on a molecular pathway that leads to cancer growth.
Three types of uveal melanoma cells were grown in the lab with cancer mutations which were treated with FR, which was found to effectively block the growth of uveal melanoma cells. When uveal melanoma cells were treated with FR they appeared to revert from cancer cells to typical melanocytes; and higher doses of FR killed the cells according to the researchers who suggest the compound could be used to treat uveal melanoma one day.
The team would like to repeat the findings in a mouse model of uveal melanoma as was done in the lab, moving towards testing in humans to develop new strategies for combating uveal melanoma.

SURGERY PLUS MEDICATION MAY BE BEST FOR HIDRADENITIS SUPPURATIVA

Adalimumab therapy can get hidradenitis suppurativa under control in advance of surgery to repair associated scars and fistulas, says Jacek Szepietowski, president of the Conference of the European Hidradenitis Suppurativa Foundation. Adalimumab is the only FDA-approved biologic drug for the condition, but research is underway on monoclonal antibodies as well as adjuvant therapy with methotrexate, Szepietowski says.

American Board of Cosmetic Surgery Denied Right to Advertise as "Board Certified" in California

Today, the Medical Board of California (MBC)  took a major step to protect patients in the  state when it unanimously voted against allowing members of the American Board  of Cosmetic Surgery (ABCS) to advertise  as “board certified” cosmetic surgeons.  ASPS is proud to have worked in advance  of this vote to educate the MBC  and show that ABCS certifications  are not backed by a level of training that puts them on par with American Board of Medical  Specialties (ABMS) member boards. “This is, frankly, a tremendous relief.  California has a large number  of cosmetic surgery patients and the  most ABCS members of any  state, which means it holds the greatest  potential for those patients  to be misled by advertisements that a  doctor is a ‘board certified cosmetic surgeon’,” says ASPS  President Alan Matarasso, MD, FACS.  “Today’s ruling means those patients  are less likely to choose a  particular provider because they were exposed to a confusing ad.  That’s going to make patients safer.  Our specialty owes a huge debt  of gratitude to all the plastic surgeons  who invested their time and talents  to help protect our patients.” Today’s ruling closes the book on a  two-decades-long story. In 1996, California law was changed so that  the state’s physicians could only advertise ABMS certifications, unless  a non-ABMS board was specifically  reviewed and deemed equivalent to  an ABMS member board by the MBC.  ABCS has applied for equivalency under this process multiple times, and the MBC has repeatedly found that  ABCS falls short of the state’s standard that requires their training programs  to be equivalent in scope, content, and duration to training accredited by  the Accreditation Council for  Graduate Medical Education (ACGME).

WSJ analysis: Referrals driven by desire to keep business in hospital systems

The Wall Street Journal (12/27, A1, Mathews, Evans, Subscription Publication) reports hospitals employ a variety of strategies to encourage physicians to make referrals that keep patients within the hospital system, even when a patient may benefit from seeing a specialist outside the network. Leakage occurs when patients go to competitors for care, threatening the $1.8 million in revenue annually hospitals see from internal-medicine referrals for services like tests, according to a 2016 Merritt Hawkins survey. As hospitals acquire more physician practices, the pressure on new physicians to avoid leakage has mounted. One study found patients pay $90 more out-of-pocket for MRIs when administered in a hospital, while doctors working for the hospital system were 27 percent more likely to steer patients to the hospital for the scan.

Unfortunately, as more and more plastic surgeons are hired by hospitals, the hospital employed internists and family physicians are instructed to refer to these hospital based plastic surgeons, despite the fact that they may not have as much experience in certain cases.   It's all about the money and hospitals want to control patient flow. 

A sad state of affairs!!!  

E.B.G.