As the cliche goes, "a picture is worth a thousand words." Well, a video may be worth even more. Here is a selection of short movies that clearly introduce skin cancer for those newly diagnosed.

What is skin cancer? - This easy-to-understand video explains what how the different types of skin cancer affect the different layers of the skin.

Mohs surgery - This patient education video from the American College of Mohs Surgery covers all the basics of skin cancer and details the Mohs surgery process.

Skin biopsy - Dermatologist Dr. Coyle Connolly performs a biopsy for skin cancer on a suspicious lesion found on a patient's forehead.

How to do a skin self-exam -  The Melanoma International Foundation presents this video overview of performing skin examinations, a key way to detect skin cancer in its early, treatable stages.

Surgery for Melanoma - The University of Maryland Medical Center introduces melanoma in this video, including risk factors, biopsies, surgical treatments, and more.

A potential new treatment for actinic keratosis (AK; commonly called "sun spots") has just completed a critical phase III clinical trial. AK is a pre-cancerous skin condition that appears as a dry, scaly lesion caused by prolonged and repeated sun exposure. The American Academy of Dermatology reports that 40% of cases of squamous cell carcinoma begin as AKs. If the results of the trial are positive, it could be a serious competitor to imiquimod (Aldara) for the treatment of the most common forms of skin cancer.

The new treatment, called PEP005, is a topical gel containing a molecule called ingenol 3-angelate. It is derived from the milky sap of a common garden weed called the petty spurge or radium weed (scientifically, Euphorbia peplus), which has long been used as a traditional folk medicine in many countries for the treatment of skin conditions. It activates a molecule in the body called protein kinase C, which in turn helps control various cellular functions. The previous phase II trials showed promising results: after applying the gel for only two days, 71-75% of the lesions disappeared after two months. Side effects were no more serious than localized redness and peeling. PEP005 is also being studied for the treatment of basal cell carcinoma, bladder cancer, and even leukemia.

This is the proper way for natural products to enter the market: use "traditional" knowledge and "home remedies" for initial ideas, then isolate the specific chemical that is responsible for the effect, then thoroughly test it using double-blind clinical trials. You might be surprised to learn that the herbs, supplements and homeopathic remedies on your store shelves don't typically go through this process -- and for that reason, are usually no more effective than a placebo.

_Source:

_{"Peplin Completes Enrollment for its First Phase III AK Clinical Trial." Peplin. 2 January 2009.}

The most common treatment for nonmelanoma skin cancer such as basal cell carcinoma (BCC) is surgery: either simple surgical excision (removal) or Mohs surgery. Excision is used to treat both primary and recurrent tumors and involves surgically removing the tumor and a certain amount of normal-appearing skin surrounding it (the "margin"). The Mohs procedure is more complex: it involves removing thin sections of the skin growth one at a time, each of which are individually examined under a microscope until no cancerous cells remain. However, clinical trials directly comparing the effectiveness of the two techniques are few and far between.

Klara Mosterd, MD and colleagues at Maastricht University in the Netherlands recently published just such a study. Over 400 patients were treated with either of the two techniques and then followed for five years. The results showed that Mohs surgery is more effective than surgical excision for the treatment of recurrent BCC on the face, since there were significantly fewer recurrences. However, because there was no significant difference in recurrence of primary BCC between the two groups, treatment with surgical excision is probably sufficient in most cases of primary BCC.

Although this is just one study, it's a potentially important one for public policy. Excision is less expensive than Mohs, so in this age of tightening health care costs, it could be used more often to treat certain types of basal cell carcinoma in the future.

_Source:

_{Mosterd K, Krekels GA, Nieman FH, et al. "Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up." 2008. Lancet Oncol 9(12):1149-56. 27 December 2008.}

Add another feather in the cap of elesclomol, a novel experimental drug for patients with stage IV metastatic melanoma. Elesclomol previously received "Fast Track" and "Orphan Drug" designations from the FDA -- both essentially votes of confidence -- and now it has passed a safety analysis with flying colors.

Elesclomol is the first of a new class of cancer drug. It acts by increasing the level of stress in cancer cells, which causes them to self-destruct (technically called "apoptosis"). It is currently being tested in a phase III clinical trial (called "SYMMETRY") in combination with another cancer drug called paclitaxel; the first results will be presented in 2009. In the earlier phase II study, the elesclomol and paclitaxel combo doubled the median time that patients with stage IV metastatic melanoma survived without their disease progressing, compared to paclitaxel alone. If that result holds up, it would be a significant and welcomed advance in melanoma treatment. The side effects are unpleasant but manageable: fatigue, hair loss, constipation, nausea, insomnia, diarrhea, and anemia have been reported.

Be sure to ask your doctor if you are eligible to participate in this promising clinical trial. Let's hope that 2009 is a good year for elesclomol . . . and for patients with advanced melanoma.

_Sources:

_{"Synta Announces Continuation of the SYMMETRYSM Trial Based on Evaluation of Independent Data Monitoring Committee." Synta Pharmaceuticals. 21 December 2008.}

_{"The SYMMETRY study." Synta Pharmaceuticals. 21 December 2008.}