Page 17 - Boca Club News - July '19

Boca Club News, Page 17
Health & Wellness

Medical Matters: Skin Cancers (Part Two--Melanoma)

By Richard Nagler, M.D., a member Huntington, N.Y. especially on the face, arms, legs, soles of the feet, palms of
of Broken Sound Club and retired This is by far the most dangerous skin cancer. Each year the hands, under the fingernails, eyes, and even the intestines.
physician. After graduating from the there are about 100,000 new cases of malignant melanoma They are benign, but any change in an existing mole should
University of Pennsylvania and New in the USA: 55,000 in women and 45,000 in men. There are immediately alert an individual to seek medical attention.
York University’s School of Medicine, 9,300 deaths, with 6,200 in females and 3,100 in males. Most An asymmetrical irregular shape, or the mole developing
Dr. Nagler served his internship and are over age 60. In recent years the incidence has been rising. two different halves that can be notched or scalloped, a change
residency at Baltimore City Hospital It is most common in whites, but more dangerous in African in color becoming multicolored or an uneven distribution
and Johns Hopkins. He followed that Americans defying early detection. Melanomas begin in the of color, an increase in size greater than ¼ inch, and the
with a Fellowship in Gastroenterology melanocytes that control the pigment in the skin. Exposure to development of itching or bleeding, should immediately alert
at Yale University School of Medicine, and was then Chief the UV rays of the sun is the major cause for of these cells to one to the development of a malignancy. It is important to
of Gastroenterology at Fitzimmons General Army Hospital become malignant. be aware that melanomas may develop in the hidden areas
in Denver. He returned to the Yale Medical School for one Most people have between 10 to 45 moles, many described earlier in this column, as well as anywhere in the
year as an Assistant Professor of Medicine before opening developing after age 50. They are of uniform color--usually digestive tract, urinary tract, vagina and the mucus membranes
his own successful private practice in Internal Medicine tan, brown or black, which separate them from the surrounding in the nose, mouth and esophagus. When it appears in the
and Gastroenterology. During that time, he also served for skin. They are most often small, about the size of an eraser on whites of the eyes, visual disturbances may occur.
ten years as Chief of Medicine at Huntington Hospital in a pencil--round or oval. They can appear almost anywhere, Risk factors include fair skin, which affords less protection
from UV rays due to excessive sun exposure, especially in
individuals living near the equator or at high altitudes. A family
Delray Design Center history of melanoma, having more than 50 moles, or unusual
ones that are larger, irregular with a mixture of colors and a

The diagnosis requires a biopsy with removal of the entire
weakened immune system all pose significant risks.
design sales installation lesion, including a small border of normal skin for microscopic
analysis, which includes measurement of the thickness of the
mole where the thicker it is the worse the prognosis. A sentinel
node biopsy, which involves the lymph node closest to the
Custom Cabinetry melanoma testing for any malignant cells is essential. If it is
negative it is good evidence that it hasn’t metastasized. However,
for there are instances where a sentinel node biopsy is negative, but
the disease has spread, usually directly into the blood stream.
Kitchens Staging of the disease is essential for prognosis. Stage
0 is where the mole is in situ with abnormal cells, but no
Bathrooms cancer. Stage 1 A is where the lesion is just 1 mm thick with
no ulcerations and has a prognosis of 97 % five-year survival.
Closets In 1 B the lesion is 1-2mm thick with some minor ulceration
and the five-year survival rate is 90%. In stage 2 A the tumor
Entertainment is greater than 2 mm thick with a five-year survival of 80%,
and in 2 B with ulceration 70%. In stage 3 it can be any size or
Centers shape, but has spread to a lymph node and five-year survival
is 50%. With stage 4, where it has widely spread to the lungs,
liver and brain, survival is less than 15%.
Treatment: For very thin melanomas, they can be removed
Stone and Tile for Counters, Flooring and Wall Tile entirely with a border of normal tissue and a layer of skin
beneath the lesion. No further treatment is needed. With larger
melanomas, removal of all nearby lymph nodes is done. High
Porcelain, Marble, French Limestone, Granite, Quartz, Terrazzo. doses of chemotherapeutic agents with isolated limb perfusion
Fabricated to size at our own Delray Manufacturing Facility. in the vein of an arm or leg permits the drug to go directly to
the lesion with no adverse effect on the rest of the body.
Radiation therapy can help to relieve symptoms. There are
In-House Design very encouraging results from ongoing clinical trials involving
Service for the use of checkpoint inhibitors, which enable the patient’s
own immune system to fight melanomas that have spread
remodeling and to the brain. This form of immunotherapy does not work for
new construction everyone, but when successful the results are remarkable.
Fifty-six percent of patients in these studies were significantly
for helped with the brain and other metastatic sites disappearing

Complete in 28% and shrinking in 30%. However, 50% had significant
side effects, including severe headaches, fever, chills, brain
Kitchens, swelling and inflammation of the heart, and 20% quit the
Baths, Closets, trials because of them. Targeted therapy with agents such as
Office and Zelboraf, Tafinlar and Mekinist prolong survival, but works
only in 50% of patients who have a certain genetic mutation.
Entertainment Vaccines using weakened melanoma cells to jump-start the
Cabinetry immune system have had mixed results thus far. Survival
depends entirely on the earliest possible diagnosis. Once it
has metastasized it is generally fatal.
Another promising treatment option involves combining
Custom cabinets for Closets and Specials manufactured at immune therapy with the direct injection of a modified herpes
our own manufacturing location in Delray virus or the HPV vaccine into melanoma lesions. In many
patients this has resulted in improved survival times and a
better quality of life.
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