Photo Finish: New Therapy Takes Aim at Precancerous Lesions

Related Document: Photodynamic Therapy.pdf (Reprinted with permission
from the Messenger-Inquirer)

Article highlights photodynamic therapy through the experiences of patients.

While growing up, summertime for Carla Payne meant being outdoors. "If the sun was shining, my mother put us out in the yard to play," said Payne, 63, of Maple Heights. Sunscreen was a rarity then and later as a teenager when she hung out with friends at the old Miller's Lake near Moseleyville.
"You're indestructible. You don't think anything is going to happen to you," Payne said. Ten years ago, something did happen to the fair-skinned woman. Red, crusty patches slightly smaller than a pencil eraser popped up two or three at a time on her temples, forehead, arms, legs and back. They were precancerous lesions called actinic keratoses, the earliest stage of skin cancer that shows up on the outer layer of skin because of long-term sun exposure. The spots would be cut or frozen off, leaving semi-circular or half-inch white scars. But in May, she underwent three sessions of photodynamic therapy, a relatively new treatment using light to activate a topical lotion that kills precancerous cells in most cases.

"I could tell the next week my face looked...smoother," Payne said of the first treatment by Dr. Michael Crowe at Owensboro Dermatology. The procedure also has been used to treat acne, and early data have dermatologists thinking it could prevent pre-skin cancers. If so, "then we've entered a whole new era," said Dr. Michael Gold, a Nashville dermatologist who took part in the original clinical trials of the topical lotion. More data won't be in until the end of the year, but patients from five years ago have very few, if any, recurrences of pre-skin cancers, Gold said.

"Photodynamic therapy is progressing into this unknown world we're trying to define," Gold said Friday in a phone interview. "This is one of the most intriguing new therapies we've had in years."

How it works:
The process came to the United States from Europe in the late 1990s, Gold said. In 2000, the federal Food and Drug Administration approved the lotion, which contains the only photosensitizer available in the United States, he said. It is marketed under the brand name Levalen Kerastick by Boson-based (Levulan Kerastick by Boston-based) DUSA Pharmaceuticals Inc., for which Gold is a consultant. The lotion is applied to the patient's face 30 minutes to an hour before treatment. A laser, LED or intense pulse light is then shown on the treated area. The length and intensity of exposure depends on the patient's condition. Once exposed, the body converts the lotion to protoporphyrin IX, a photosensitive enzyme. Certain cells - including pre-cancerous ones and those in sebaceous glands where acne forms - absorb the enzyme. In the presence of light and oxygen, "it selectively gets destroyed...and it takes with it what's there" leaving normal cells undamaged, Gold said.

Dermatologist Dr. Trey Truett likens it to a smart bomb hitting the cellular structure of the damaged cells. "When the light hits it, it's kind of like throwing a wrench into the machinery," said Truett with Owensboro Dermatology, which has treated 50 patients since it started using the therapy in January.

"What we know is, if you do that, about 90 percent of the pre-skin cancers disappear," Gold said. Photodynamic therapy leaves patients sensitive to sunlight for 24 to 36 hours after a treatment, so they must stay indoors.
"Those days, I read a good book and just relax," Payne said.

Testing the lotion:
In its infancy, photodynamic therapy required applying the lotion 14 to 18 hours before treatment. "The biggest problem with the treatment was that you got red and crusty at the sites of the lesions, which took up to about a week to heal," Gold said.
The lotion was expensive, and only certain light could be used, Truett said. Later testing showed different lights could be used, the lotion could be made cheaply and patients could have it applied only an hour or so before treatment.

And it still had the same 90 percent success rate, Gold said. Doctors later learned it would smooth skin, so the process is now sometimes used for photo rejuvenation for the whole face, Gold said. In the past two to three years, the process has been used to treat severe to moderate acne. "It works, for some people, miraculously," he said. Studies have shown acne does not recur in most cases, and little maintenance is needed, he added.

Truett said the process also is being used to treat adult acne and wrinkles. All of its uses are done with a minimum of damage, compared with cutting or freezing spots, Truett said. "This is probably the method that is going to give the best cosmetic result," he said.

By David Blackburn
Messenger-Inquirer

Dermatology Practice Nominated for Small Business of the Year

Related Document: Small Business Nomination.pdf (Reprinted with permission
from the Messenger-Inquirer)

Owensboro Dermatology received a nomination for Small Business of the Year Award from the Owensboro Daviess County Chamber of Commerce.

...Also at the 7:30 a.m. breakfast at the Executive Inn, the chamber will honor its entrepreneur of the year and two small businesses of the year. And the meeting will kick off the chamber's second annual "Owensboro Has It!" campaign. Forty chamber members are participating in a cooperative advertising campaign to promote shopping Owensboro merchants first. Nearly 1,700 radio ads promoting the campaign are planned for June and July on local stations along with 500 ads on Adelphia cablevision. Thursday's breakfast will also feature all 40 companies at a business expo. Nominees for entrepreneur of the year are Wayne Foster, American patriot Getaways; Glenn Taylor, Glenn Funeral Home; Colby MacQuarrie, Colby's Fine Food and Spirits; and Darrin Payne, Darrin's Cleaners.

Small business of the year is divided into two categories. Nominees in the category for one to 10 employees are THA Engineering Solutions, Rivertown Moving & Stroage and Legends Golf & Soccer. In the 11 employees and larger category, the nominees are Comfort Keepers, Daymar College, Owensboro Dermatology Associates, Glenn Funeral Home, Colby's Fine Food and Spirits, and Darrin's Cleaners. Reservations must be made by calling the chamber at 926-1860 by noon today. The breakfast costs $9 for chamber members and $11 for nonmembers. For people who just want to drink coffee, the charge is $2.

By Keith Lawrence
Messenger-Inquirer

‘The Sun Is Not Your Friend:’ Early Detection Helps Men Fight Skin Cancer

Related Document: The Sun is Not Your Friend.pdf (Reprinted with permission
from the Messenger-Inquirer)

Dr. Crowe talks about the sun, suntans and skin cancer.

For Kirk Kirkpatrick, it was a small mole on his right thigh that he had never noticed before. Larry Moore thought the small bump on his right cheek was an infected shaving cut. What the two men have in common, other than a lifetime of working or playing in the sun, is skin cancer--and the fact that they caught it early. The American Cancer Society's Web site says about one million people each year are diagnosed with skin cancer, with most of those being nonmelanoma cases. Melanoma, the most serious type of skin cancer, will comprise nearly 60,000 cases of skin cancer this year and about 7,800 of the 10,600 skin cancer deaths, the site said. The problem for Kirkpatrick was the mole he found on his leg in May 2001 fit none of the typical characteristics of melanoma. It was round, single-colored and hardly raised, he said. "I would have never gone to a doctor except I had a mole on the back of my neck that was bothered by my collar," Kirkpatrick said.

But he went, and the trip likely saved his life, said Kirkpatrick, 53, president of the WaxWorks/VideoWorks Inc. video division. The mole was removed and found to be malignant. At his doctor's request, Kirkpatrick returned for what he thought was going to be an outpatient procedure to remove a bit more flesh. Instead, a surgeon cut a 13-inch oval from his knee to near his hip and removed several layers of skin from around the site of the mole, he said. Three days later, Kirkpatrick learned he had a very aggressive form of melanoma that had gotten into his sentinel nodes. He learned it had not spread to his lymph nodes--which could have allowed cancer cells to travel throughout his body--after doctors cut into his right groin and removed the nodes.

During a special surgery, a tourniquet was fitted on his right leg before a mixture of heated blood and a powerful dose of chemotherapy was circulated to kill off cancer cells. The leg was then drained, but "what little chemo was left made me sick as a dog," Kirkpatrick said. For the next year, he took interferon, a drug that simulates the flu, with all its symptoms, and causes the body to increase white blood cell production to boost the immune system. Kirkpatrick said he was given a 30 percent chance of living. With the special surgery, it went up to 50 percent, then up to 70 percent if he added the interferon, he said. "Those were not numbers that impressed me," Kirkpatrick said. He was probably within two months of dying had the mole not been found, he said. He's close to five-year mark at which a case of cancer is considered cured, Kirkpatrick said. Though he is now more susceptible to a recurrence somewhere else on his body, he added, "My story is one of the few that's going to have a happy ending."

Moore, the former Kentucky Wesleyan College athletic director, hopes for a similar result as he awaits the biopsy results from the bump removed from his cheek April 27. It was the second spot removed since 2002, when a bump in a crevice of his right nostril turned out to be basal cell carcinoma--the most common and least dangerous form of skin cancer. That spot was removed from his nose, and a flap of skin taken from near his left ear was grafted over the dime-sized hole, Moore said. The fact that the first spot was benign makes Moore less worried about the latest bump, he said. Besides, he added with a shrug, "There's nothing I can do about it."

But Moore, as well as Kirkpatrick, is now more diligent about covering himself. "After this (nose surgery) occurred, I make sure I cover myself when I go play golf," said Moore, a former shirtless gardener and Florida beach vacationer who dons a hat and sunscreen. Kirkpatrick has been an avid swimmer since childhood and used to compete on the Owensboro Country Club team.

"No one loved the sun more than I did when I was a kid," said Kirkpatrick, who used to favor tanning lotion over sunscreen. "The sun is not your friend."

A tan is actually a mild injury to the skin, said Dr. Michael Crowe, a dermatologist with Owensboro Dermatology on New Hartford Road. "A tan is your body's response to ultraviolent radiation," said Crowe, who shakes his head now when recalling his college years at UCLA studying on the beach. Melanoma usually occurs in areas most exposed to sunlight, but "it can show up anywhere," he said. Sunlight was once thought to stimulate the body to produce Vitamin D, but milk and dairy products provide plenty of that for most people in Western countries, Crowe said. For the most part, people now protect themselves well, Crowe said. But some put on sunscreen thinking they can sun longer and be protected, he added. "I think they get a little more (sun) than they would otherwise," Crowe said.

And then there are those who extend the tanning season through migration or indoor tanning. Skin cancer usually shows up in people in their 50's and 60's, especially those who travel to warmer climates in the winter and rural residents who spend a lifetime working outdoors, Crowe said. "We do see them in younger ages now," he said, particularly college-age women in their early 30s who hit the tanning beds in the winter. Crowe attributes that to the combination of tanning beds and sunning outdoors. Fortunately, skin cancer is visibly noticeable, and early detection can often mean a cure, said Kirkpatrick with the been-there knowledge of the formerly ill.

The trouble is, it takes a long time to show up, he said. "It happens when you're a kid and takes 20 or 30 years to show up," Kirkpatrick said. For him, he added, "The bomb was lit in 1970. It's just got a really long fuse.

"The best prevention, other than limited and protected UV exposure, is frequent checking and monitoring of moles, Crowe said. "I think the common denominator for all these cancers...is if you have a growth that is changing, those are all warning signs," he said.

Having melanoma "is a life-changing event. It makes you appreciate every single day," Kirkpatrick said. "Until someone looks you in the eye and says, 'You've got a 30-percent chance to live,' you don't get it."

About Skin Cancer
Most skin cancer is caused by the sun or ultraviolet (UV) light. People who are fair-skinned, easily burned, have red or blond hair and have a family history of skin cancer are the most susceptible.

The three types of skin cancer are:

--Basal cell carcinoma, a raised, reddish or translucent nodule that affects up to 400,000 people a year, according to the American Society for Dermatologic Surgery. It rarely spreads, but left untreated, can cause severe local damage.

--Squamous cell carcinoma, which shows up as a red, scaly patch on the ear lobes, face, lips and mouth in as many as 100,000 people a year. It can spread to other parts of the body.

--Melanoma, a malignancy of melanocytes, the cells that produce the skin-darkening protective pigment called melanin. The disease affects only 4 percent of all skin cancer cases but is the leading skin cancer killer. The warning signs of melanoma include spots that are asymmetrical; have ragged or blurred borders; have shades of tan, brown or black; and are wider than six millimeters, or about the size of a pencil eraser.

By David Blackburn
Messenger-Inquirer

New Treatment for Pre-Cancerous Skin Lesions Offered Locally

Dr. Michael Crowe

Dr. Artis Truett, III

Related Document: PDT therapy.pdf (New treatment for pre-cancerous skin lesions)

Owensboro Dermatology and Henderson Dermatology are one of the first dermatology practices to offer a new treatment, Photo Dynamic Therapy (PDT), for pre-cancerous skin lesions (actinic keratoses).

Dr. Michael Crowe, Board-Certified Dermatologist with Owensboro Dermatology, said, “Our group has a number of lasers and treatments available prior to purchasing these new machines. However, in dermatology many different types of equipment/treatments are presently being used to treat a variety of skin conditions, growths and cosmetic complaints. No single laser or piece of equipment is currently capable of treating all skin conditions.”

Skin cancer is the most prevalent of all cancers. According to the American Academy of Dermatology, an estimated more than one million Americans develop skin cancer every year. Actinic Keratoses (AKs) are considered the earliest stage in the development of skin cancer. AKs can change and turn into squamous cell carcinoma, a type of skin cancer. Basic treatment for AKS has been cryosurgery, surgical removal and biopsy, topical chemotherapy, chemical peels, and laser skin resurfacing.

“We wanted to provide the community with another alternative to treating actinic keratoses (pre-cancerous lesions),” Crowe added. “This new treatment has shown improved therapeutic results, reduced risk of infection, limited injury to normal skin, and could potentially cause less scarring.”

PDT uses LED light waves that are targeted on the area that needs treatment. Movable lights wrap around the area while the patient lies on the table. First, a light-sensitive medicine is administered topically. Within a period of three hours, the medicine concentrates in diseased cells while it avoids normal tissue. The medicine remains inactive until exposed to the light. When applied, the light energy, delivered to the pre-cancer site, chemically activates the active metabolite and creates a toxic form of oxygen which destroys the cancerous and pre-cancerous cells with minimal damage to healthy cells. Most PDT treatment can be performed on an outpatient basis. The treatment time is variable depending on the growth. Usually pre-cancer is treated once a week for up to three weeks dependent on the lesions.

Dr. Artis Truett, Board Certified Dermatologist with Owensboro Dermatology, sees patients in the Owensboro and Henderson locations. This treatment is currently offered through the Owensboro office. However, patients seen at Henderson Dermatology who meet certain clinical criterion can also benefit from this new treatment through the Owensboro location.

Truett said, “The added bonus of this treatment for pre-cancer is that it is non-invasive and painless with minimal side effects such as redness that goes away in a few hours.”

Local Dermatologist Speaks at International Conference in Ecuador

Dr. Artis Truett, III

Dr. Artis Truett, Board Certified Dermatologist with Owensboro Dermatology Associates and Henderson Dermatology, was asked to speak at the International Dermatology Exchange Program of the Skin Cancer Foundation held in Quito, Ecuador.

Dr. Truett spoke at two separate sessions. The first session he discussed contact dermatitis and patch testing as a viable diagnostic tool. At the second session, he highlighted how technology is impacting medical records and physicians’ offices, “The Benefits and Hurdles of Going Paperless.” Dermatologists from around the world were in attendance at this January conference.

This conference is recognized by the American Academy of Dermatology for continuing medical education credits. The International Dermatology Exchange Program of The Skin Cancer Foundation offers a conference agenda, featuring a faculty of prominent experts in their field. Three half-day sessions covered advances in diagnosis and treatment, reconstructive surgery techniques, and discussion of difficult or unusual cases in dermatology.
Dr. Truett earned his medical degree from Duke University School of Medicine. He was an adjunct clinical instructor for the Department of Medicine at Vanderbilt University School of Medicine. He is a member of the American Academy of Dermatology, the American Contact Dermatitis Society, the American Society for Mohs Surgery and the American Society for Laser Medicine and Surgery, among others.