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Skin Cancer

CISS relies strongly in its evaluations below on impartial analyses by the International Cochrane Collaboration and the British Medical Journal’s Clinical Evidence Group – two groups of researchers who specialise in Evidence Based Medicine.

Conventional medicine supports the paradigm that states that the tumour is the first stage of cancer; therefore, treating and removing the cancer should cure the cancer. Unfortunately, statistics show this is rarely the case. Conventional medicine also advocates treatment should only be used if supported by appropriate clinical trials showing efficacy.  Evidence based medicine suggests that the only reliable evidence for efficacy comes from properly run randomised controlled trials (RCTs). As mentioned below, none of the RCTs evaluating conventional intervention for cancer have shown any clear benefit.  Therefore, the conventional cancer paradigm needs to be questioned.

Much of the following descriptions are based on the conventional cancer paradigm with comments from CISS inserted where claims have not been established.

The US National Cancer Institute states that “Cancer is a genetic disease—that is, it is caused by changes to genes that control the way our cells function, especially how they grow and divide. Genetic changes that cause cancer, can be inherited from our parents. They can also arise during a person’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. (There is little evidence for this claim – CISS)

The skin is the body’s largest organ. It protects against heat, sunlight, injury and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer).

The two main types of so-called skin cancer are non-melanoma skin cancer and malignant melanoma. (The non-melanoma skin cancers are not really cancer, ie they are not malignant.  Cancer, or malignancy, is defined as a condition where cells multiply and invade surrounding tissue – CISS).

So-called skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, hands, and arms. It is especially common among people with light skin.

Skin cancer begins in the epidermis, which is made up of three kinds of cells:

  • Basal cells: Round cells under the squamous cells – producing basal cell carcinomas (BCCs);
  • Squamous cells: Thin, flat cells that form the top layer of the epidermis – producing squamous-cell carcinomas (SCCs);
  • Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural colour. When skin is exposed to the sun melanocytes make more pigment and cause the skin to darken – sometimes producing malignant melanomas. (The causal link between exposure of the skin to the sun and the formation of malignant melanomas has not been established. In fact many melanomas form on parts of the body not exposed to the sun, such as the soles of the feet – CISS)

Actinic keratosis is a skin condition that sometimes becomes squamous cell carcinoma.

Non-melanoma skin cancer

Basal cell carcinomas (BCCs) are the most common form of non-melanoma skin cancer accounting for 75% of skin cancer. Most are not malignant in that they do not normally invade surrounding tissue.

Squamous cell carcinomas (SCCs) make up about 20% and about 3% become malignant and grow by spreading into surrounding tissue.

Basal-cell and squamous-cell cancers rarely result in death. In the United States they were the cause of less than 0.1% of all cancer deaths [1].  (In this sense most (ie 95% of) skin cancers are similar to carcinomas in situ (CISs) that are often found when screening for other types of cancer, such as breast and cervical cancer – CISS.)

Because most non-melanoma skin cancers, the BCCs and SCCs, are not malignant they are no longer included in the national cancer statistics. When certain websites do include them in their cancer statistics they often wrongly describes skin cancer as the most common type of cancer and produce a greatly inflated figure for cancer survival. For example the Cancer Council Australia web site states that “Skin cancers account for around 80% of all newly diagnosed cancers”.[1]. Their Sunsmart website states that “Sun exposure is the cause of around 99% of non-melanoma skin cancers and 95% of melanomas in Australia”. (As mentioned above, the proof for the second part of this statement has not been established – CISS.)

Reference: Cancer Council Australia website:

http://www.cancer.org.au/about-cancer/types-of-cancer/skin-cancer.html

Malignant Melanoma

Melanomas, the only truly malignant skin tumours, make up about 2-5% of skin cancers.

Globally in 2012 melanoma occurred in 232,000 people, and resulted in 55,000 deaths. Australia and New Zealand have the highest rates of melanoma in the world [2]. About 2.1% of men and women will be diagnosed with melanoma during their lifetime. The death rate is about 2.7 deaths per 100,000 people.

The three main types of skin cancer have become more common in the last 20 to 40 years, especially in those areas which are mostly Caucasian [2].

In Australia more than 12,500 new cases of melanoma are reported each year, out of which more than 1,500 die from the disease. The mortality rate of basal-cell and squamous-cell carcinoma is around 0.3% (US).

Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths

Signs and Symptoms: 

Melanoma accounts for 8% of cancers diagnosed and 2% of deaths in Australia. It is the fifth most common cancer in the Australia after prostate, colorectal, lung and breast cancers and the fourth highest among men.

There are no known dietary risk factors for skin cancer:

Treatment:

Four types of standard treatment are used in conventional medicine for early skin cancer and three additional types are used for particular situations or for more advanced skin cancers:

  1. Surgery: Surgery to remove the lesion. Often more tissue needs to be removed layer after layer until no more cancer cells can be detected.
  2. Curettage and electro-desiccation: Cancer cells are scooped out with a cutting device and the bleeding is stopped using electric current.
  3. Laser therapy: Tissue destroying laser light is used to vaporise the cancer cells.
  4. Chemosurgery/MOH (microscopically controlled excision after chemical fixation of the tissue)
  5. Radiation: This is generally used where tissue destruction and removal would interfere with function, eg a tumour on the eyelid.
  6. Chemotherapy: The use of toxic drugs to kill the cancer cell or stop them from growing.
  7. Immunotherapy: In severe cases, immune stimulants are used in an attempt to stimulate the body’s own defence mechanisms. These might involve interleukin-2 (IL-2) or interferon (IFN), although the side effects are often severe and the benefits limited.

A more recent development is the use of immune checkpoint inhibitor antibodies. These antagonist monoclonal antibodies are capable of unleashing dormant or exhausted antitumor immunity, which has led to durable complete and partial responses in a large number of patients. Ipilimumab targets the cytotoxic T lymphocyte-associated protein 4 (CTLA-4) receptor. Nivolumab and pembrolizumab target programmed cell death protein 1 (PD-1) receptors and have proven to be superior to ipilimumab alone. The combination of ipilimumab and nivolumab has yielded higher response rates, greater tumor shrinkage, and longer progression-free survival than either monotherapy alone.

“Response rate” and “progression–free survival” are not valid measures of efficacy.

Reference:  Redman JM et al. Advances in immunotherapy for melanoma. BMC Med. 2016; 14: 20.

(Note: There is little evidence that surgery for malignant melanoma has any benefit on increased percentage 5-year survival or reduced mortality as there has never been a randomised controlled trial to demonstrate such benefits. (The Efficacy of surgical treatment of cancer – 20 years later, DJ Benjamin). Similarly, there is little evidence of any significant benefit from using chemotherapy to treat malignant melanoma. Research by Morgan et al concluded that chemotherapy for malignant melanoma gives no increased percentage 5-year survival benefit. For immunotherapy, there is no evidence to date from RCTs of any significant increase in overall survival compared to placebo. CISS)

Early detection: Because the skin is readily seen most skin cancers are found by people themselves or at medical check-ups.  Campaigns designed to increase awareness of what skin cancers look like have increased the incidence of skin cancer.

Overdiagnosis:  Such campaigns have resulted in significant overdiagnosis and overtreatment of non-melanoma skin cancers.

Before deciding on one of these treatments you would benefit from asking your physician three questions:

Question 1: What are my treatment options? – these should include doing nothing.

Question 2: What are the possible outcomes of those options? – including benefits and side effects.

Question 3: How likely is each of the outcomes to occur?

If you feel your doctor or other health practitioner is not able to answer these questions, or shows that he or she is not comfortable with you asking these question, it suggests they are not practising evidence based medicine and you should consider getting another opinion.

These three questions can be expanded.

For a complete comprehensive overview of conventional treatments used for different types of skin cancer with up to date information on % effectiveness of each treatment on mortality and morbidity, please follow this link to the various Moss Reports:

The Moss Report on Basal Cell Carcinoma;

The Moss Report on Squamous Cell Carcinoma;

The Moss Report on Melanoma.

Alternative Paradigm

Another paradigm states that cancer is a systemic disease and the tumour is only a late stage symptom, element or manifestation of that disease. Therefore, treating the disease should be systemic and wholistic (meaning treating the whole body) and should include the following principles:

  1. Treatment should cause no harm.
  2. Treatment should be Wholistic (i.e. consider the whole person – body, mind, emotion and spirit).
  3. The person with cancer needs to take control of their own health. This latter paradigm is supported by CISS (See Introduction to CISS).                              

Alternative cancer therapies are generally consistent with the above principles. In fact, those believed to be the most effective in controlling cancer – psychotherapy and immunotherapy – also have strong supporting evidence from randomised controlled trials.

There are approximately 200 alternative cancer therapies that have been shown or anecdotally reported to help a person with cancer have reduced morbidity and mortality. The following are those used for the non-melanoma skin cancers and for malignant melanoma with the most scientific evidence for benefit. What is important in any cancer treatment is to both understand and believe in your chosen therapy.

Non-melanoma skin cancers

There are three creams or ointments commonly used to treat non-melanoma skin cancers, Curaderm, Cancema and Black Salve.

Curaderm

Curaderm is a cream developed by an Australian doctor, Bill Cham and is the one with the best evidence to support it and with the fewest side effects. While conventional treatment for non-melanoma skin cancer often leaves a scar, Curaderm usually does not. Curaderm is available via the internet.

Cancema and Black Salve are reported to produce more painful reactions when applied to the skin.

All three topical treatments have been criticised by cancer authorities as being harmful and ineffective, although Curaderm has several trials supporting its benefits.

Ralph Moss, Cancer Therapy, The Independent Consumers Guide to Non-Toxic Treatment and Prevention, reports the following alternative therapies have been shown to produce benefits for non-melanoma skin cancers:

Hoxsey method – This is a combination of herbs developed by Harry Hoxsey. They include poke root, burdock root, barberry root, buckthorn bark, stillingia root and prickly ash bark. (Many of these individual plant substances have shown marked therapeutic activity.) He also developed a special escharotic salve for the treatment of skin cancers that was a paste containing zinc chloride, antimony trisulphide and the herb blood root. A related conventional version of this salve is known as Mohs’ microsurgery. Mohs reported that the treatment produced a “99% cure rate for all primary basal cell carcinomas he treated” (Reference 19, p.165).

References:

Patricia Spain Ward in US Congress Office of Technology Assessment. Unconventional cancer treatments.  Washington DC, US Government Printing Office, 1990.

Mohs FE. Chemosurgical treatment of cancer of the skin. A microscopically controlled method of excision. JAMA 1948; 138: 564-9.

Malignant melanoma

For malignant melanoma one therapy that has been evaluated in a randomised controlled trial is Structured Psychotherapy.

  • Structured Psychotherapy

Fawzy et al evaluated the benefits of structured psychotherapy on a group of 68 people with early stage malignant melanoma randomised into two groups of 34 each with one group treated.  Those in the treated group received regular psychotherapy in groups of 7-10 for 1½ hours a week for six weeks. They found significant survival benefits from the intervention compared with those in the untreated control group after 5-6 years.  At a 10-year follow-up they found that the survival benefit of the intervention had weakened since the 5- to 6-year follow-up; however, it had not entirely disappeared.

Reference: Fawzy I et al. Effects of a Brief, Structured Psychiatric Intervention on Survival and Recurrence at 10-Year Follow-up Arch Gen Psychiatry. 2003; 60:100-103.

Another therapy that has been found useful for reversing melanoma is immunotherapy.  This comes in many forms.

  • Immunotherapy

Issels’ Wholebody Therapy: Although not based on RCTs, the most successful therapy for late stage cancers was Josef Issels’ Whole Body Therapy that focussed on restoring the body’s immune systems.

It was estimated in 1970 that a representative sample, 252 of Issels’ patients with late stage cancers experienced a 16.6% five-year survival following his treatment. This compared with less than 5% with standard treatment at the time. They also experienced a 15% 15-year survival in good health compared with less than 2% for standard treatment. This long-term surviving group included 1 with melanoma.

Reference: Issels, J.  Immunotherapy in Progressive Metastatic Cancer – A Fifteen-Year Follow-up. Clinical Trials Journal, August 1970: 357-365 – editorial by Phillips S.  Dr Joseph Issels and the Ringberg Klinik.  Clinical Trials Journal. August 1970: 355-56.

Another therapy that has been evaluated in a comparative trial, but not a randomised controlled trial is the Gerson Diet.

The Gerson Diet: Hildenbrand et al compared survival among a group of 153 patients with different stages of melanoma with those treated conventionally and found a significant increased survival at all stages.

Reference: Hildenbrand GL et al. Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review. Altern Ther Health Med. (Sep) 1995; 1(4): 29-37.

Ralph Moss, Cancer Therapy, The Independent Consumer’s Guide to Non-Toxic Treatment and Prevention reports the following alternative therapies have been shown to benefit malignant melanoma:

  1. Chaparral – Chaparral tea is prepared from a shrub called the greasewood or creosote bush of the American south-west. Scientists at the University of Utah have reported on several cases of people with melanoma whose tumours responded to the tea. (References 12-13, p. 140)
  2. Coley’s Toxins – These are mixed bacterial vaccines developed by William Coley MD after he observed that many people with cancer went into remission after having an acute infection that caused a fever. They are effective with a wide range of cancers. His results included 60% five-year survival with operable malignant melanoma.

(References 2-4, p.412) (This figure was well above that achieved with conventional treatments at the time. CISS.)

Nauts H. Bacteria and cancer – antagonisms and benefits. Cancer Surv. 1989; 8: 713-23.      

  1. Hyperthermia (Heat therapy) – Hyperthermia is increasingly used in conjunction with other conventional treatments because it has been found to enhance their effects. It is based on the observation that tumours whose temperature is raised above ~ 42°C are damaged whereas surrounding health cells are unharmed (Reference 12, p.384) Promising results were obtained with several types of cancer including skin cancers, (Reference: NCI Cancer Weekly, 5/29/89 on p.377). It is also used with some success with Tumour Necrosis Factor (TNF) for malignant melanoma of the extremity. (Ref, p.468)

(NOTE: In the last 25 years since Moss’ book was published there have been many developments in the hyperthermia area with more evidence of benefit of hyperthermia in the treatment of prostate cancer – CISS)

  1. Hydrazine sulphate – This is a chemical designed to interrupt the process in the liver whereby the waste product lactic acid is converted to glucose. It is believed that tumours are more dependent on a continuous supply of glucose than other cells. This thereby interrupts the process called cachexia, a wasting away of the body produced by tumours starving the rest of the body of glucose and causing up to 40% of late stage cancer deaths.  It has been shown to be effective for most solid tumours, including metastasised tumours, including malignant melanomas. (Reference 13, p. 321)

In addition to the above four alternative therapies there are several supplements believed to have anti-cancer properties that are not confined to specific types of cancer.

  1. Selenium – Selenium is one of them. Selenium is believed to reduce the incidence of cancer by stopping carcinogens corrupting the genetic material of the cell; slowing the spread of cancer cells; and enhancing the body’s normal anticancer immunity. Researchers believe this might explain why people who have a relatively abundant supply of selenium in their diets experience less cancer. For this reason, selenium supplements are used. The National Academy of Sciences (NAS) advises that no more than 150 micrograms of selenium be taken orally daily. However, in the treatment of cancer the dosage is generally about 10,000 micrograms (or 10 milligrams), nearly 100 times the NAS’ recommended dose. References: Schrauzer G. Selenium and cancer.  A review. Bioinorganic Chemistry 1975; 5: 275-81. Schrauzer GN et al. Cancer mortality correlation studies III.  Statistical associations with dietary selenium intakes. Bioinorganic Chemistry 1977; 7: 23-24. Ladas HS. The potential of selenium in the treatment of cancer. Holistic Medicine 1989; 4: 145-156.

(NOTE: In many Western countries, the soil is claimed to be depleted in selenium as result of several factors.  As a result, less selenium is present in locally produced foods.  This suggests supplementing the diet with selenium-rich foods or with selenium supplements in forms such as selenomethionine. CISS)

  1. Turmeric – Applied topically as a poultice for skin cancers is reported to have significant effects in reducing skin pain, offensive odours and itching with only rare side effects.
  2. Vitamin D – Supplementing with vitamin D is based on the observation that those with vitamin D deficiency have a higher incidence of melanoma. Research with sailors, who had a higher incidence of melanoma than other people, identified that it was those who spent more of their time indoors who had the most melanoma. This has led to the hypothesis proposed by researcher John Ott that full spectrum light is essential for health, so working outside should be beneficial.

(He suggests that working indoors under unnatural lighting is harmful because it does not contain light of certain beneficial frequencies.  He suggests that much of the light entering the eyes is an important factor in stimulating the hypothalamus gland, so he suggests going outside in the sun for a period each day and removing any sunglasses. Other researchers have stated that high intensity visible light, especially at the blue end of the spectrum, has been shown to have very significant harmful effects on the immune system via the serotonin/melatonin pathways.

Other researchers have suggested avoiding sunscreens, especially those containing PABA, and using natural clothing and shade for protection instead.  

It is interesting to note that those people with melanoma with the highest sun exposure appear to live longer than those with the lowest exposure. 

A trial involving Professor Bruce Armstrong from Sydney University’s School of Public Health, working with the University of New Mexico’s Department of Internal Medicine, followed 528 people with melanoma over 5 years and observed the correlation between increased sun exposure and survival with melanoma.  Contrary to expectations they observed a positive correlation, ie the higher the exposure the longer the survival.  He therefore theorised that the increased vitamin D produced by sun exposure might be the protective factor.  This result confirmed the effects he had already observed on a smaller group with melanoma in Australia. (Vitamin D’s boosting of the immune system might be one explanation – CISS)

Reference: Berwick M, Armstrong BK et al.  Sun Exposure and Mortality From Melanoma. J Natl Cancer Inst. 2005; 97 (3): 195-199.

Prevention

A variant of Vitamin A, transretinoic acid, when applied topically to a condition called dysplastic nevi syndrome, that can turn into malignant melanoma, can produce benefits (Ralph Moss, Cancer Therapy)

More Information

For a complete comprehensive overview of alternative cancer treatments used for different types of skin cancer with up to date information on % effectiveness of each treatment on mortality and morbidity, please follow these link to the various Moss Reports on skin cancer:

The Moss Report on Basal Cell Carcinoma;

The Moss Report on Squamous Cell Carcinoma;

The Moss Report on Melanoma.

If you or someone close to you has just been diagnosed with skin cancer it is important that you research and understand your chosen treatment, whether that be conventional, alternative or a mixture of both. For the best results your treatment should include physical, mental, emotional / psychological and spiritual treatments.

If you don’t know where to begin in your journey to wellness, then we suggest you read Where To StartThis provides an introduction to the alternative approach to treating cancer and also information about some evidenced based alternative cancer treatments.

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