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Combining Skin Cancer Treatments – London Dermatology

Today, Dr Conal Perrett, a leading skin expert with his own private dermatology clinic London, presents his team’s findings after trialling a combined treatment for superficial basal cell carcinoma, a common form of skin cancer.

He is speaking at the American Academy of Dermatology’s Annual Meeting in San Francisco, USA. Dr Perrett will describe the study in detail to some of the world’s leading experts in treating skin diseases.

Find out more about the American Academy of Dermatology [link: https://www.aad.org/for-the-public]

Combining two successful treatments

Dr Perrett’s work involved testing two treatments that are usually used separately to see if they worked better when given close together.

Photodynamic therapy (PDT)

A patient with a basal cell carcinoma is given a drug that is activated only in the presence of a bright light. The drug is preferentially taken up by the cancer cells and is then activated by a high intensity light directed accurately at the site of the cancer.

Activation of the drug just in that region of the skin kills the cells and destroys the skin tumour.

Results in patients treated only with PDT are good: the skin cancer in 90% of patients disappears within three months. Less than a quarter (22%) find that the cancer comes back and requires more treatment within two years.

Imiquimod cream (Aldara®)

Imiquimod cream is applied directly to the basal cell carcinoma. Its active ingredient is described as an immunomodulator. It acts on the immune system, stimulating the body’s own defences to destroy the cancer cells.

Its easy to apply and results are excellent. Around 80% of patients report that their basal cell carcinoma disappears within three months and only 20% have a recurrence within two years.

Results from The Devonshire Clinic

Dr Perrett’s latest study performed in a small number of patients treated using both PDT and imiquimod demonstrates even better results.

PDT was given first, with two treatments one week apart. Two weeks after the second PDT session, they were given imiquimod cream (5%) to apply every day for four weeks.

By three months, the basal cell carcinoma had completely disappeared in 94% of patients, which is better than the resolution rates seen with either treatment alone.

The study is still ongoing but by 12 months after the first PDT treatment session, only one patient had experienced a recurrence of their skin cancer.

Dr Perrett says: “This pilot study shows the potential benefit of combining two established treatments for skin cancer, namely photodynamic therapy (PDT) and imiquimod (Aldara®). Our results suggest that they may be more effective when used together than individually. We now need to perform a larger study to examine this further.”

About basal cell carcinoma

This form of skin cancer is very common, affecting millions of people worldwide each year. It is caused by exposure to sun in most cases.

Although basal cell carcinomas rarely spread through the skin or to other sites of the body, it can have a devastating effect on your quality of life. Tumours on the face or other visible parts of the skin can become very obvious, particularly if they grow large or ulcerate. Because they can invade into surrounding tissues and cause significant destruction and morbidity, prompt diagnosis and treatment is important

The Devonshire Clinic offers a complete skin cancer screening service with mole check on an annual basis for private patients.

To find out more or book an appointment contact our private dermatology clinic London.

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New skin cancer drug approved – London Dermatology

Fast-tracked through the new Early Access to Medicines Scheme

The new drug, pembrolizumab, has been developed to treat advanced skin cancers such as melanomas that have started to spread through the body. Although it has not yet been licensed in the UK, a new scheme has made it available for people already very ill with their disease.

‘The arrival of pembrolizumab represents an exciting new development in the treatment of advanced melanoma’, comments Dr Conal Perrett, Consultant Dermatologist The Devonshire Clinic. “It is encouraging to see that it has been fast tracked to patients by the Early Access to Medicines Scheme (EAMS), an initiative set up by the UK government last year,” he adds.

Available for patients with advanced melanoma

The Early Access to Medicines Scheme allows a drug that is showing great promise but that has not yet been approved and licensed to be prescribed by doctors and consultants for the patients who most need it. In this case, this includes people with advanced melanoma skin cancer who have no other treatment options other than palliative care.

What does pembrolizumab do?

Pembrolizumab is one of a new generation of anti-cancer drugs that focus on helping the body’s own immune system recognise and kill cancer cells. When melanoma, one of the most aggressive forms of skin cancer, starts to spread throughout the body, it can be fatal. The drug blocks a process within the cancer cells that they use to hide from the immune system.

With no ‘cloaking device’ the cancer cells are open to attack my cells of the immune system and this can help fight the cancer throughout the body.

The advantages of releasing the drug early

Usually, new cancer drugs that are already shown to be safe and show great promise need to be officially licensed by the Medicines  and Healthcare Regulatory Agency (MHRA) and approved by the National Institute for Clinical Care Excellence (NICE).

Under the EAMS scheme, regulators carry out a very thorough evaluation of the evidence behind the drug’s potential and then recommend that the drug is made available. It then goes through the normal, and often lengthy process of becoming licensed and then approved for use in the NHS.

The most severely ill patients can access treatment and more data from their response to the new drug can be collected during this time. It is hoped that this will avoid delays and will show which patients can benefit from it the most in the future.

What is melanoma?

Melanoma is a form of skin cancer that can spread through the body and that kills in excess of 2000 people in the UK every year. Spending long periods of time in the sun, or on sunbeds, is a major risk factor for melanoma.

The Devonshire Clinic offers a complete skin cancer screening service with mole check on an annual basis for private patients.

To find out more or book an appointment contact our private dermatology clinic London.

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Skin Test for Dementia – Dermatologist London

A Skin Test for Dementia Might Be on The Horizon

New research suggests that a simple skin test might be developed in the fairly near future that could help diagnose degenerative diseases such as Alzheimer’s at a much earlier stage.

“Early diagnosis is essential and it may be that the skin can provide us with the relevant clues to achieve this…,” says Dr Conal Perrett, a leading dermatologist London based with his own practice in the Harley Street district. Here he reviews the latest evidence and looks at the prospects for a future skin test that could spot the earliest signs of dementia.

What is Alzheimer’s disease?

Alzheimer’s disease is a degenerative disease of the brain that leads to dementia. Like other forms of dementia, it is highly distressing both for those affected and for their families and friends.

One of the problems facing doctors who try to treat it is delay between changes in the brain and central nervous system and the appearance of symptoms.

The first signs of forgetfulness, memory loss and changes in behaviour that are typical of Alzheimer’s are often only recognised when the damage to the nerve cells and brain tissue is quite advanced.

Detecting changes in brain tissue is impossible and Alzheimer’s is diagnosed on the basis of the symptoms that develop and that worsen over time. Diagnosing the disease more accurately and at a much earlier stage might help to delay its progression, giving people a better quality of life for longer.

The latest research on skin and Alzheimer’s

So far, researchers have tried looking for brain biomarkers in the blood to predict which patients might develop Alzheimer’s, but this has proved difficult.

A group in Mexico, at the University of San Luis Potosi, took a different approach. They looked back at the embryo for clues to direct their studies.

Studies of how the tissues of the embryo develop have shown that the brain and the skin are generated from the same clump of early cells. They share a common origin.

Dr Ildefonso Rodriguez-Leyva, who leads the group, thinks that the skin might show some of the same early changes as the brain in Alzheimer’s, other forms of dementia and Parkinson’s disease.

“The skin is a much more accessible tissue than the brain. If a test was possible, dermatologists could play an important role in taking skin biopsy samples for analysis,” adds Dr Perrett.

Looking for protein deposits in the skin

The researchers are convinced they are onto something because the protein deposits that are found in patients with Parkinson’s disease have also been observed in skin samples taken after their death. But no studies until now have looked for changes within the skin of living patients.

Deciding that the evidence was strong enough to justify a small clinical trial, the Mexican group collected together a people with either Parkinson’s disease, dementia or Alzheimer’s disease. Just a dozen or so of each, plus a dozen healthy people with no signs of brain disease.

A small skin sample was obtained from behind their ear and was examined using powerful microscopes and chemical tests.

Brain tangling proteins discovered in the skin

The results have generated a great deal of excitement among neurologists and dermatologists. They showed that two key proteins were present in much greater quantities in the skin of patients with either Parkinson’s or Alzheimer’s compared to those with other forms of dementia, or compared to the healthy people used as controls.

The proteins – tau and alpha synuclein – are known to clump up in the brain and major nerves, causing memory loss and other problems.

“The link between the skin and the brain definitely seems to be worth exploring further,” comments Dr Perrett, Medical Director and lead dermatologist at The Devonshire Clinic. “Analysis of the skin can often provide important insights into diseases affecting other part so of the body as demonstrated by this research into Alzheimer’s disease and Parkinson’s disease,” he adds.

Looking to the future

Although the results released so far appear to be very promising, a lot more still needs to be done before a test could be used in clinics. Larger clinical trials over a longer period of time are needed.

Hopefully, if things do go well, skin tests might be able to highlight early changes that will predict which people are likely to go on to develop brain disease.

 

Find out more about the medical dermatology services offered by The Devonshire Clinic.