Dr Paul Lubitz, The Association Between Alcohol and Melanoma

For the past 30 years, melanoma has been on the rise across Canada.

Melanoma is a form of skin cancer, and although it is less common than other skin cancers, it is more serious. Melanoma typically appears as brown or black spots on the skin; in some cases, it can appear as pink, tan or even white discolorations. This skin cancer can form anywhere on the skin, but is most commonly found on the chest and back in men and on the legs in women.

The American Cancer Society estimates that approximately 76,000 people are diagnosed with melanoma every year and roughly 10,000 people die annually from this form of skin cancer.

Generally, the risk of developing melanoma increases with age, with the average age of those diagnosed with the cancer being roughly 63.

UV rays and sun exposure are often blamed for the development of the skin cancer, and while being sun smart is incredibly important and something I regularly advise, there are other risk factors that can lead to the cancer that people should be aware of.

Having a history of melanoma in one’s family makes one a high-risk candidate for the cancer. Similarly, anyone who has a lot of irregular or large moles has been shown to have an increased risk. Those who have fair skin, freckling and light hair should be aware that they are also at a higher risk for melanoma.

Outside of genetic predisposition, new research published by the American Association for Cancer Research indicates that there also may be a correlation between alcohol consumption and the development of this skin cancer.

Eunyoung Cho, ScD, an Associate Professor of Dermatology and Epidemiology at the Warren Alpert Medical School of Brown University, recently published the study, Cancer Epidemiology, Biomarkers & Prevention, which suggests that alcohol intake is linked with an increased risk for melanoma.

The study used data taken from 210,252 participants who were followed for an average of 18.3 years; the study used food-frequency questionnaires to measure alcohol consumption and frequency.

In a powerful takeaway from the research, Cho and her colleagues concluded that alcohol intake was linked to a 14 per cent increase in melanoma risk per drink, per day, with the association between alcohol and melanoma being the greatest for parts of the body that normally get less sun exposure.

Those who consumed 20 or more grams of alcohol a day were two per cent more likely to develop melanoma on their head, neck, arms or legs, but 73 per cent more likely to develop melanoma on their back or stomach.

The research also concluded that the largest risk for melanoma came from consumption of white wine, with each drink per day of white wine associated with a 13 per cent increased risk.

Eunyoung Cho’s study is only the most recent research that supports the fact that alcohol is a carcinogen. Outside of skin health and melanoma risk, alcohol has been considered a carcinogen by the International Agency for Research on Cancer (IARC) for many years, and in 2014 a World Cancer Report found that alcohol accounts for 3.5 per cent of cancers around the world.

Now, the point of this article is not to urge readers to stop drinking alcohol entirely. But rather, to urge moderation when it comes to drinking alcohol, and as always, to emphasize skin health by staying sun smart, living a healthy, active lifestyle, getting regular skin exams by a Board Certified Dermatologist and regularly examining one’s skin for irregularities.  

Dr Paul Lubitz: Adult Acne – How to treat it.

Often dismissed as an adolescent condition, many people don’t realize that acne is a skin condition that many adults suffer from. In fact, some patients don’t experience acne for the first time until well into their adult years. It’s estimated that five percent of all adults over the age of 45 suffer from adult acne, and one in five women between age 25 and 40 experience regular acne breakouts.

The most recent research has demonstrated that the majority of adult acne is the result of a genetically predetermined abnormality of the pilosebaceous (oil producing) glands of the body. While multiple factors, such as hormonal changes, can contribute to exacerbations of the acne at different times in a patient’s life, including during adulthood, the root cause of acne is a fundamentally abnormal gland to some degree.

Unlike teenage skin, adult acne is more challenging to treat due to the special needs of adult skin. Older skin is much more prone to dryness; adult skin is also more prone to showing signs of aging and may be more sensitive to acne treatments designed for oilier, more resilient teenage skin.

“People used to think that acne was just a cosmetic issue, but it’s a chronic skin condition with intermittent flare-ups and relapses,’ says Dr. Bethanee Schlosser, director of the Women’s Skin Health Program at Northwestern University in Chicago.

As we age, collagen production slows down, which in turn slows the skin’s healing process. This delayed healing response commonly increases the duration of each acne episode of adult acne as compared to teenage acne and increases the possibility for post-acne scarring. This means that treating adult acne needs to done as early as possible and on a case-by-case basis.

While adult acne is challenging to treat, there are some things adults can avoid to decrease the intensity and frequency of acne flare-ups.

 Adult Acne Skin Care Tips 

 1. Avoid Stress 

It’s been proven that stress both physiological and psychological causes an increase in androgens, which stimulate sebaceous and pilo-sebaceous glands. These glands produce the oil that moisturizes our face and hair follicles. But, when sent into overdrive, these glands can overproduce oil, and become irritated and that can clog pores and contribute to acne.

2. Changing Birth Control 

Oral contraceptives contain estrogen and progesterone hormones, which can control androgen activity. Changing pill brands or coming off of it completely can create acne flare-ups because androgen activity is increased. Certain IUDs contain progesterone and can also contribute to acne.

3. Pregnancy and Menopause 

Pregnancy presents many changes in a woman’s body - one of those is the increase of the androgenic hormone, progesterone; the hormone responsible for causing sebaceous glands to be stimulated and can result in overproduction of oil that results in flares of acne.

Menopause is marked with strong fluctuations in hormones, which can lead to heightened sebaceous gland activity, causing pimples.

4. Prescription Drugs 

As we age, some of us require prescription medication to treat illnesses and conditions. While they are designed to improve our quality of life, some medications can trigger or worsen adult acne. Barbiturates used as sleep aids, lithium for treating depression, and corticosteroids are well known acne agitators.

5. Makeup 

Used to enhance beauty and self-confidence, oily skin care products and occlusive makeup can often be bad for the skin, especially acne-prone skin. Even though your skin may be dry, the additional oils in your skin care products can clog and irritate the skin. Look for non-oily, light coverage alternatives, which will hydrate the skin without clogging the pores.

To reduce and prevent adult acne flare-ups, get to know your skin. If you have sensitive or dry skin, it’s best to use a gentle cleanser and an alcohol-free toner along with a calming mask, as opposed to the oily skin acne treatments that may cause dryness. Harsh cleansers, toners and abrasive scrubs will only irritate the condition.

Drink lots of water. Drinking at least 6 - 8 glasses or 8 ounces of water daily will keep skin hydrated and help dilute the skin’s secretions, preventing pore congestion.

Look to changing your diet if you notice an increase in oil activity after certain meals. In some cases reducing the fat content of the diet can help slow the increase of sebum in the skin. Eating foods rich in antioxidant vitamins keeps the skin healthy and in good condition.

Protecting the skin from the sun may not prevent acne, but it will ensure your skin is healthy and able to combat irritants effectively, which is key to fighting adult acne. Unprotected UV radiation from the sun can also contribute to more noticeable acne scars as the skin’s collagen and elastin support structure break down.

Fortunately, there are many very successful treatment strategies available for adults suffering from acne. It is important though that adults with acne are correctly diagnosed early in the course of the disease so that an effective treatment can be initiated in order to prevent progression of the acne and morbidity including scarring.

Early Diagnosis and safe and effective treatment of adult acne most often requires the expertise of a dermatologist, a professional skin specialist, with experience treating a variety of skin types, familiarity with traditional acne medications, and knowledge of the many new medical and non-medical treatment options now available.

Dr Paul Lubitz: Remember Melanoma Awareness Starts with ‘Me’

It’s a little known fact that melanoma skin cancer is the most common type of cancer diagnosed in women aged 25 through 29. According to the Cure Melanoma Organization, one person dies every hour from this often-preventable disease.

May happens to be Melanoma Awareness month. The month is meant to spark conversation around this common cancer and encourage people to check their skin and visit a dermatologist regularly for their skin examinations.

One of the most notable initiatives during the May awareness campaign is Melanoma Monday. Held on the first Monday of the month, the event sees members of the Canadian Dermatology Association (CDA) visit Parliament Hill in the nation’s capital to provide skin cancer screenings for all Members of Parliament, Senators and their staff.

The annual May event highlights the importance of skin monitoring and draws nationwide media coverage, which the organization uses to promote skin cancer awareness. This year’s key area of focus is the dangers of tanning beds.

Ahead of this year’s event in Ottawa, the CDA released a video aimed at teenagers and tanning bed users. Capitalizing on Prom Season, the video entitled "You Got into That Bed", is a clever and informative discussion about the risks associated with tanning beds.

The video aims to drive home the important statistic that sunbed use before the age of 35 years increases the risk of melanoma by an incredible 35 percent.

"It seemed like a natural fit for us," said Dr. Vince Bertucci, President of the CDA, "targeting Canada's most important leaders, our elected officials, with one of Canada's most at-risk populations, teenagers. In this way we hope to avert tragedy in both current and future leaders."

In Canada and across the globe, skin cancer is the most common and prevalent form of cancer in humans. The number of those diagnosed with Melanoma and other forms of skin cancer such as Basal Cell and Squamous Cell Carcinomas continues to grow each year with roughly 85,100 new cases diagnosed in 2015.

At this point, you may be asking, “Dr Paul Lubitz, what should I do to protect myself?”

As this year’s Melanoma Awareness Campaign points out, avoiding all exposure to tanning bed rays is the first step in protecting your body’s largest organ.

Routine checks for changing moles, skin discoloration, easy bruising and other skin abnormalities are also key components to preventing skin cancer. Research indicates that high-risk patients (people who spend a lot of time in the sun, have a history of skin cancer in their family, or have a fair skin type) that routinely perform skin checks are much more likely to find any skin cancers including Melanoma in its earlier stages. Consequently, by having their skin cancer detected early, their chances of dying from the cancer were reduced by as much as a 63 percent.

Today, there are even mobile apps you can download on your phone or tablet that can help you track and monitor mole growth, colour, size and other changes. This data can be compared over time so you can stay on top of your skin health.

The regular application of sunscreen (an SPF of + 50 is recommended for the Bow Valley), wearing sun protective head gear and clothing while in the sun, and avoiding excessive sun exposure in the peak 10 – 2 hours of the day, are all important behaviours that will further reduce your risks of developing skin cancer. 

Dr Paul Lubitz: When to book a skin cancer screening and what to expect

As Cancer Awareness Month (March) draws to a close and the weather begins to warm up, it’s a particularly appropriate time to highlight the importance of protecting against and early detection of skin cancer. Many people are still unaware that skin cancer is the most pervasive form of cancer. In fact, according to the Skin Cancer Foundation, over the last three decades, more people have had skin cancer than all other cancers combined.

This shocking statistic is attributed to all the multiple forms of skin cancer, with the most invasive and serious form being melanoma. Even though melanoma accounts for roughly 1 percent of skin cancer cases, it carries the highest mortality rate. An estimated 1,150 Canadians die annually from the disease and it’s reported that every 52 minutes an American dies from melanoma and related complications.

To avoid being one of the new diagnoses, it’s crucial that you protect and monitor your skin. When found early enough, almost all skin cancers are treatable and not life threatening.

Dr Paul Lubitz - Guide to Skin Cancer Self Screening

First, for a successful self-exam, you need to know what to look for. Take note of any new moles or skin growths and any monitor existing growths that begin to grow or change significantly. Lesions that itch, change, bleed, or don't heal are also warning signs you should be aware of.

An easy way to remember what to look for with respect to moles is with the acronym: ABCDE.

Asymmetry - Refers to the shape of a mole. A malignant mole is often asymmetrical where if the lesion is cut in half, one side does not look like the other side while a benign mole is symmetrical.

Border - Again referencing shape, border refers to the outer edge of a mole. Malignant moles tend to have a rough, non-uniform edge or border. Moles that have an irregular border are often an indication of early melanoma.

Colour - A mole that is multiple colours within the same lesion or demonstrates different shades other than brown is often an indicator of skin cancer. Melanomas often appear to have hues of red, white, black or blue.

Diameter - Unlike A and B, diameter relates to the size of the mole. Non-cancerous moles usually have a smaller diameter than malignant ones. A good rule of reference is the size of an eraser tip of a pencil; melanomas are usually larger in diameter than the 6 mm eraser tip.

Evolving - This characteristic or trait of a mole requires the monitoring of moles for change over a period of time. Be on the alert for any changes in size, shape, color, elevation, other traits, or any new symptoms such as bleeding, itching or crusting. If you recognize any of these characteristics, it is important to book a screening examination with a certified dermatologist, an accredited skin specialist.

“What should I expect from a professional skin cancer screening, Dr Paul Lubitz?”

A skin cancer screening is easy, painless and relatively quick. A regular and complete skin screening should be a regular part of a health care regimen, especially for those people who spend a lot of time outdoors, or for people that live in a high-risk area such as the Bow Valley because of the higher elevation.

1. First, an initial assessment is conducted where information about a patient’s history and predisposition to skin cancer is gathered. Questions are related to: your family and personal skin history, skin cancer history, frequency of sun exposure, history of sunburns, whether you've ever used indoor tanning beds and how often and the type of sun protection you use.

2. From there, a physical examination is conducted carefully examining any moles, lesions or skin growths. In some cases, your dermatologist may use a magnifying lens, magnifying glasses or a sophisticated instrument called a dermatoscope in order to better examine questionable skin lesions.

3. If there is an area of concern, the doctor will then discuss his findings with you, at which point you both can decide on an effective course of action which might include a skin biopsy, digital imaging or careful observation of the skin lesion.

Performed regularly, self-examinations and professional screenings can alert you to changes in your skin and aid in the early detection of skin cancer. Self-exams should be done at least once a month and a complete skin examination ideally by a board certified dermatologist should be booked annually or sooner if you notice any of changes listed above.

Dr. Paul Lubitz on What It Means to Be a Canadian Royal College Accredited Dermatologist.

The past four years that I’ve spent living and practicing as a dermatologist in Canmore Alberta have truly been some of the most enjoyable years for me, both professionally and personally.  I love the abundant nature and wildlife here almost as much as I love the Canmore culture that places a priority on balancing work with living and enjoying life.  

There’s no other place right now where I would rather practice my medical profession than Canmore, which is part of the reason why I’m establishing my own private dermatology centre in the town this summer.  To be located in downtown Canmore in Suite 204 at 1240 Railway Avenue, my Centre, called Art of Skin Dermatology and Laser, will offer a knowledgeable and trained medical staff, as well as comprehensive and advanced diagnosis and treatment options for a wide variety of medical, surgical, laser and cosmetic skin diseases and conditions. Art of Skin will be equipped with advanced laser treatment technology, including fractionated CO2, Erbium, Yag, Alexandrite, and Radio Frequency to name a few, which will enable us to treat in a safe and effective fashion everything from excessive hair growth, to removing unwanted pigmentation, blood vessels and moles, to improving skin laxity, removing wrinkles and improving scars, to treating precancer and skin cancer lesions.

I’m very excited for the opening of Art of Skin; but I’d like to stress another very critical reason for why I’m opening my own centre and why, more generally, I think it’s incredibly important that residents of Canmore and the Bow Valley have access locally to advanced skin care diagnostic and treatment options provided by a Canadian Royal College accredited dermatologist.

As I’ve undoubtedly communicated before, in the four years I’ve practiced as a dermatologist in Canmore and to a lessor degree in the years before, I, along with most of my dermatologist colleagues in the province, have noticed a trend of residents in large and smaller centres to be increasingly seeking the medical and surgical advice, diagnosis and treatment of non dermatologist physicians – and even non-physicians for an increasing number of potentially serious skin-related issues and medical and surgical skin conditions.

Instead of seeking the expertise of a trained and Royal College accredited dermatologist, an increasing number of patients are consulting the advice of quasi, so-called skin care “specialists”, such as estheticians, beauty department employees, drug store employees, pharmacists, nurses, other para-medicals, and even dentists.  And the scope of this trend is not relegated to cosmetic needs – more patients are visiting non-physicians and non-dermatologist physicians who propose to be skin specialists for advanced medical information and to diagnose and treat complicated problems such as resistant acne, troublesome eczema and psoriasis that has failed multiple initial treatments. In some cases, patients are seeing these non-dermatologists for assessment and treatment of pre-cancer and even skin cancer lesions. In many cases, missed or incorrect diagnoses at the hands of non-dermatologists have resulted in very serious consequences for the patient. For example, I recently had to perform multiple surgeries on a young lady for several skin cancers on her face that had been misdiagnosed as eczema by a non-dermatologist for several years.

This is an enormous concern for myself as a dermatologist, especially considering the fact that this trend is not only seen in Canmore and the Bow Valley area.  In many other areas of Alberta and Canada, an increasing number of people are going to proposed “skin specialists” to be treated for a variety of skin-related issues, so much so that the Alberta Society of Dermatologists (ASD) is currently in the process of establishing a provincial media campaign to help educate the public as to what is a dermatologist in terms of training, skills and expertise, what it means for a dermatologist to be accredited as a Fellow by the Royal College of Physicians and Surgeons of Canada, why it is important to be seen by a dermatologist for skin concerns and diseases, and finally how the public can identify who in the province is an accredited dermatologist.

A few simple ways for a patient to determine the training of a particular physician is to ask the physician if he or she is an accredited dermatologist with the Royal College of Physicians and Surgeons of Canada, to look at their business card or to pay attention to the certificates hanging on the office wall. Such a physician will identify them self clearly as an accredited dermatologist, and have FRCPC written after their name. Only a dermatologist accredited with the Royal College can use the initials FRCPC to identify themselves as a Fellow of the Royal College of the Physicians and Surgeons of Canada, specialist in Dermatology.

Alternatively, a search on the website of the College of Physicians and Surgeons of Alberta will give a list of accredited Dermatologists in the province. A patient can find this information by coping the following address into their browser search bar: http://www.cpsa.ab.ca/PhysicianSearch/SearchResults.aspx?Specialty=Dermatology

Interestingly, the Royal College of Physicians and Surgeons of Canada (RCPSC), the governing and accrediting body who is responsible for accrediting all specialists (including dermatology) in the country has itself recognized a need to further educate the public on the value, in terms of training, skills, requirements and commitment to long-term learning, of specialists accredited by the Royal College in Canada. To this end, the Royal College has recently undertaken a nationwide campaign to promote what it means for any specialist (including dermatologists) to be accredited by its governing and administrative body.

You can read more about this subject by going to the Royal College microsite. Simply copy the following web address and paste it into your browser’s search bar.

https://fellowshipmatters.royalcollege.ca/fellowshipmatters/en/index.html

As part of their campaign, The Royal College (RCPSC) has communicated that accredited dermatologists are committed to the lifelong learning and continuing professional development of their dermatological knowledge.  Their campaign has also communicated that RCPSC Fellows take part in the Royal College’s Maintenance of Certification (MOC) Program, which includes mandatory participation in ongoing activities such as conferences, workshops, seminars, rounds, journal clubs, small-group learning sessions, and self-assessment programs.

In my mind, there is no doubt of the importance that patients, whenever possible, see medically trained and Royal College accredited dermatologists for issues related to their skin’s health.  There is also no doubt in my mind of the importance of patients confirming whether the physician who states they are a ‘skin specialist” is, in fact, an accredited dermatologist. If the physician is not a dermatologist, the patient does have the right to ask to be referred to a dermatologist.

I know that the potential risk for improper and incorrect diagnosis and treatment of skin conditions and diseases dramatically escalates when a patient seeks the guidance and trusts the knowledge of non-dermatologist, non-physician’s for their skin concerns. Similarly, I know first-hand of the severe complications, let alone sometimes permanent psychologic and physiologic damage and financial expense to patients that can result when patients follow the untrained and unregulated advice and treatment of these individuals.

As mentioned, I’m greatly looking forward to opening my Art of Skin Centre that will function in addition to my current general Dermatology clinic at the Canmore General Hospital. These two complementary clinics will provide an important resource for Bow Valley and region residents where they can obtain knowledgeable, experienced and responsible guidance from a Royal College Dermatologist, an accredited Skin Specialist. 

  

Desire, Passion and Dedication Lead to Distinction

‘Medical’ and ‘school’: two everyday words you’ve no doubt run across hundreds, if not thousands, of times in your life. It would be safe to say that neither one by itself for most people conjures any real emotions. Put the two together, though, and a different story begins to emerge.

‘Medical school’: the combination of the individual words results in a concept that goes above and beyond the two words separately. This idea is known as synergism. It is defined as cooperative action of discrete agencies such that the total effect is greater than the sum of the two taken independently.

The term ‘medical school’ carries with it a whole host of connotations and meanings that were not present in the two words individually. Think about attending medical school and what comes to mind? LOTS of studying? Sleep deprivation? Hundreds of polysyllabic words – like pneumonoultramicroscopicsilicovolcanoconiosis – that you need to understand? How about simply long, or difficult?

“Medical school is difficult,” admits Dr. Paul Lubitz, “as well it should be. Medical school is there to train future doctors; individuals to whom you will entrust your very life. You want them to have gone through rigorous training.”

So what qualities does it take to succeed in medical school – agreeably some of the most difficult years many will face? “It takes dedication,” states Dr. Paul Lubitz. “And – perhaps more important – it also takes desire, and passion. Each quality on its own is a wonderful thing. But one without the others will not suffice. The qualities must work together.” Many have the desire to attend medical school but not the dedication. On the other hand, many have the dedication to attend medical school but not the desire or passion. Desire, passion and dedication must all be present to make this endeavor work successfully.

“Desire and passion were present in me from an early age. I had the desire to learn and excel, desire to push my limits of understanding, desire to increase the caliber and extent of my skills, and, even from a young age, the desire to help others,” explains Dr. Paul Lubitz. My passion for obtaining knowledge, for being the best I could be, and for helping others provided me with the strength and courage to pursue my dreams of becoming a physician particularly important when challenging situations arose.

“Once I identified what I wanted to do with my life, dedication – to the study of medicine – joined desire and passion and gave me the tools necessary to succeed in the difficult task ahead.”
And succeed he did. Dr. Paul Lubitz didn’t just graduate from medical school; he graduated with Distinction. “Medical schools bestow this honor to demonstrate that the graduate is an exceptional doctor, above others in his field as far as knowledge and expertise are concerned and that he has a high level of dedication to his field.”

Dr. Paul Lubitz’ distinction is evident in his many achievements within the medical field including numerous publications in respected medical journals and a Government of Guyana Certificate of Merit presented by the then Prime Minister, the Honorable Dr. Samuel A. Hinds, in grateful recognition of Dr. Paul Lubitz’ contribution to the health system of Guyana, South America.

“Desire, passion and dedication should not be left behind once a student graduates,” says Dr. Paul Lubitz. “These qualities should be exhibited throughout that doctor’s career.” Desire, passion and dedication can take many forms. In Dr. Lubtiz’ case, he has routinely visited underserved and impoverished areas in both African and South America in the past and more recently in the Northwest territories, Newfoundland and Labrador in order to provide residents with essential medical services. His clinic is also actively involved in training future generations of medical doctors through rotations and electives.

“What is my advice to prospective med students and practicing doctors alike?” Dr. Paul Lubitz offers. “Cultivate your desire. Nurture your dedication. Follow your passion. Grow them together and they will lead you to personal success far beyond your wildest dreams.”