Medical Breakthroughs 2013: Exposing Skin Cancer

One of the Hudson Valley’s top medical breakthroughs in 2013



Dermatologist Dr. Heidi Waldorf examines a patient

Photograph by Ken Gabrielsen

One in five Americans will likely develop skin cancer at some point, and the American Cancer Society estimates about 77,000 new cases of melanoma — the most dangerous form of the disease — will be diagnosed in 2013.

“We are seeing many more cases of melanoma over the years,” says dermatologist Alan Schliftman, who has a medical practice in White Plains. The increase is due, at least in part, to increased public awareness and earlier detection during annual skin exams, he says.

Fortunately, new treatments and technologies are constantly in the pipeline. “A new oral drug, vismodegib, was recently approved [in 2011] for treating nonsurgical basal cell cancers,” adds Dr. Schliftman, who is also the director of dermatology at Westchester Medical Center and Maria Fareri Children’s Hospital. “And the drug vemurafenib is another oral medication approved by the FDA in 2011, which is used to treat melanoma.” 

Melanoma can be especially tricky to diagnose, since it sometimes mimics the appearance of other benign moles or spots on the skin. But now, a new FDA-approved handheld device known as MelaFind provides extra information that helps dermatologists detect melanoma and decide if a growth should be biopsied.

Using imaging technology originally created by the U.S. military to detect guided missiles, the device is placed over the suspicious mole or spot. Its lighting component — comprised of 10 wavelengths of light but not ultraviolet light or X-rays — is then shone on the skin to “see” the inner structure of the lesion just below the surface, identifying whether there is a high level of irregular growth, which could signal melanoma.

The unit’s computer function then analyzes 75 characteristics of the mole, and compares them to a database of thousands of archived images of melanoma and other skin diseases. In less than a minute, an assessment can be made — giving added information to the dermatologist, who can then decide what treatment steps, if any, should be taken. 

According to MelaFind’s manufacturer, in one study the device demonstrated 98.3 percent sensitivity to determining melanomas; while in an accompanying study without the unit, only 72 percent of melanomas were detected.

“What is special about MelaFind is that it determines, using a complicated system of algorithms and a large database, if a mole is highly disorganized or not,” says Dr. Schliftman. “These findings aid us in deciding if we feel it is necessary to remove the mole and have it sent to the lab for further testing.

“What is also great about this device,” he adds, “is that if a mole is borderline and is found not to need a biopsy, we can watch the mole and refer back to the MelaFind picture and results at any time.”

Dr. Schliftman says he and dermatology Nurse Practitioner Ellie Christianson have been using MelaFind in his practice since August 2012, adding, “We are proud to offer our patients the latest technology in melanoma detection.”

With the rise in melanoma cases, Dr. Heidi Waldorf of Waldorf Dermatology & Laser Associates in Nanuet says, “Of particular concern is the increase in melanoma among young adults, and, as statistics show, even children.” She notes several factors linked to melanoma, including multiple and/or abnormal moles, a family history of skin cancer, fair skin, and excessive sun exposure.

“As a cosmetic dermatologist, I am amazed by the number of women, even in their 20s and 30s, who come to me asking for skin rejuvenation, when they are continuing to damage it with ultraviolet light, both indoors and out,” Dr. Waldorf says.

The first line of defense in detecting melanoma is a head-to-toe exam by a dermatologist, says Dr. Waldorf, who is also director of laser and cosmetic dermatology at Mount Sinai Medical Center in New York City.

New technological advances can also be a boon in detection. “The OCT (optical coherence tomography) is a device used to scan and produce images of skin lesions from epidermis and dermis,” Dr. Waldorf says. “The physician then evaluates those images. A colleague of mine at Mount Sinai uses it to evaluate benign and malignant skin lesions, and has worked with me using it to evaluate effects of antiaging treatments we are studying.”

The bottom line, the doctor advises, is to get regular skin checks, keep an eye on moles and other skin changes, and see a dermatologist right away if anything appears suspicious. She recommends the American Academy of Dermatology’s guidelines: “Look for ‘ABCD’ — asymmetry, border irregularity, color change, and diameter greater than a quarter of an inch,” she says.

“And just remember the old American Academy of Dermatology adage: ‘See spot. See spot change. See a dermatologist.’ ”

Dr. Waldorf offers these tips to help prevent damage to the skin:

  • Sun protection is important year-round. First thing in the morning, apply a sun-protective cream, lotion, powder, or spray on any area of the skin likely to be exposed to the sun.
  • Use products with an SPF (sun protective factor) greater than 15 daily, and higher than 30 SPF in summer or if outdoors for a long period. Also look for products containing at least one of the following active ingredients for UVA protection: titanium dioxide, zinc oxide, avobenzone, mexoryl or tinosorb (the last is not available yet in the U.S.). Apply sunscreen at least 30 minutes before outdoor exposure, then reapply within the first hour outdoors, and every two to three hours afterward, plus following swimming or sweating.
  • In addition to sunscreen, wear sun-protective clothing, hats, and sunglasses; and seek shade when possible, especially between 10 a.m. and 2 p.m., when the sun’s rays are strongest.

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