Live Well Ohio: May 2017

Rays of Hope 
Here’s how three Ohio hospital systems are working to find new ways to treat and prevent a variety of skin cancers.

As we near summer, warmer weather invites the snow weary to shed  a layer and get outside. No matter the activity, one piece of gear is essential: sunscreen. While prickly shoulders and pink noses might seem like minor complaints after a day at the beach or on the trails, too much sun exposure can lead to the development of skin cancer. Because May is Melanoma/Skin Cancer Detection and Prevention Month, we talked to researchers and doctors across Ohio who are working to find new ways to treat and prevent a variety of skin cancers. 

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Zalfa Abdel-Malek, Ph.D., a researcher at the University of Cincinnati Cancer Institute and professor at UC’s College of Medicine, has dedicated her career to determining some of the genetic components that contribute to skin cancer susceptibility. 

Abdel-Malek’s work has shed light on the development of skin cancers, and in 1995 she helped pinpoint a gene that activates pigment production and helps protect against the threat of skin cancer. Called MC1R, or melanocortin 1 receptor, the gene is most active in people who live in equatorial regions and weaker in populations that see less exposure to the sun.

“If you happen to be someone with very fair skin ... chances are you have a nonfunctional form of this gene,” Abdel-Malek says. “You’re not making this protective pigment.” 

Abdel-Malek and her team discovered that less functional forms of the gene also hindered the cells’ ability to repair damage done by ultraviolet radiation. 

“We decided to focus on this hormone that activates this receptor and turns on the tanning response and our ability to make pigments,” she explains.

The hormone in question is the alpha-melanocyte-stimulating hormone, or alpha-MSH, and Abdel-Malek says tests using peptides — a string of three or four amino acids rather than the 13 present in MC1R — was enough to activate the pigment-stimulating cells in people who have reduced activity of the gene.

“Our goal,” she says, “is to develop these little peptides in a way that you can apply them topically, and this can help you obtain a tan without sun exposure.”

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Researchers at University Hospitals in Cleveland are studying the various aspects of many different kinds of skin cancer, with their focus ranging from detection to treatment to prevention. 

“There are multiple kinds of cancer that can occur in the skin — some are exceedingly rare, and others are very common,” says Dr. Kevin D. Cooper, chairman of the department of dermatology at University Hospitals and Case Western Reserve University. 

One area of particular interest is research regarding cancers in younger patients, including a program that’s focused on adolescents and young adults. 

“You’re not supposed to get cancer so early,” Cooper says, “but they probably have some kind of genetic predisposition or environmental interaction with their genetics that makes them more likely to get melanoma.” 

The more Cooper and his fellow researchers can learn about the reasons why the cancers occur, the likelier they will be able to treat them earlier. 

“One of our young doctors has recently identified, in a pair of siblings, a new gene that seems to be responsible for the early development of melanoma,” says Cooper, adding that University Hospitals’ Dr. Meg Gerstenblith is also looking at the genetic traits of these adolescents, including whether they tend to have red hair or freckles. In time, Cooper says, they hope to investigate the various genes at play in young adults who develop melanomas. In fact, University Hospitals has a center focused on youth cancer patients with its Angie Fowler Adolescent & Young Adult Cancer Institute. 

“If you’re an adolescent,” Cooper says, “you have your own set of special needs when you have cancer.” 

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In Columbus, The Ohio State University Wexner Medical Center’s husband-and-wife team of Drs. Craig and Christin Burd have developed a model they hope will help explain the disparity between the development of melanoma in men and women. 

“The project basically tries to answer the question: Why do men get melanoma and die more frequently than women?” explains Craig. 

Christin developed the model to test melanoma susceptibility by inducing melanoma in mice by way of ultraviolet exposure. By comparing a normal set of mice to a set of mice without a specific protein known as estrogen receptor beta, the team hopes to confirm their theory that estrogen plays a part. 

“Our hypothesis is that your estrogen receptor beta is protective,” Craig says. “That’s why women get melanoma less; the activation of estrogen receptor beta is protecting them.”

The study is in a preliminary stage, but Craig says he and his fellow researchers hope it will support what they’ve seen in other studies. 

“We can see that estrogen receptor beta is decreased in more advanced melanomas than less advanced melanomas,” he says. “That’s one of the indicators that maybe estrogen is important.” 

Craig is already considering the real-world implications of the study. “Theoretically, if we could prove that estrogen receptor beta is protective,” he says, “you could potentially try to activate [the protein] through ingredients in sunscreen.”

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Why You Should Skip the Tanning Bed: It’s a common misconception that spending time in a tanning bed can help acclimate your skin to the harsh rays of the summer sun. Zalfa Abdel-Malek, Ph.D., a researcher at the University of Cincinnati Cancer Institute, suggests skipping the fake tan this year. “What you’re really doing is not synthesizing more pigment,” she says, “you’re oxidizing what is in the cells and distributing them to the skin. This is not at all protective.” She adds that tanning beds claim to be a way to get vitamin D, which is found in sunlight. However, Abdel-Malek points out that the only safe way to get vitamin D is by taking daily supplements. 

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Go Team 
From exercise classes to sports leagues, more people are seeking organized fitness activities with a social side.

For many people, the exercise habit starts young with youth soccer leagues and other sports that encourage and inspire students to swing, run, shoot and dive — be it in club and intramural leagues all the way up to the varsity level.  

But as we grow older, the desire to lean on organized sports as exercise becomes more difficult, especially since higher-impact games of our youth such as basketball can lead to injuries as the years pass by, making it tough for those who want to lace up and compete. 

“If I had to go back, I would play golf and I would play tennis,” says Bob Galbreath, associate professor of exercise physiology at Ohio University’s eastern campus. “Those are the ones … if somebody wants a lifetime sport.”

From a fitness perspective, golf is less beneficial for younger athletes because walking 18 holes doesn’t come close to reaching a teenager’s maximum heart rate. “But when you turn 50 or 60 years old,” Galbreath adds, “your heart rate gets closer to what the maximum is — [it] does more benefit.” 

While teeing up serves as a low-impact way to be active as an older adult, Scott Swanson, associate professor of exercise physiology at Ohio Northern University, says he has noticed more people looking for opportunities to join a team or organized classes as a way to reconnect with sports.

“People usually are going to gravitate away from individual sports and go toward something that has that fitness edge and has the social aspect,” he says. “You’re not necessarily going to see a lot of people doing competitive swimming … because you can’t talk when you do that, but you’re going to see them involved in water aerobics.” 

Pinpointing your abilities is key to finding the right sport, according to Swanson.

“If you’re a sedentary individual, the best thing to do is get a physical to make sure there are no underlying things you didn’t know about,” he says.

For people who want some one-on-one coaching, he directs clients to resources such as the American College of Sports Medicine or the National Strength and Conditioning Association. Additionally, he says, keep in mind that longer recovery times come with aging, and you may need a day or two between practices. Beyond that, both Galbreath and Swanson say to follow your heart when choosing an organized activity. 

“For a kid or for an adult, [ask yourself] which one do you like?” advises Swanson. “Which one are you going to make time for? Which one are you going to miss when you don’t do it?” 

If you aren’t sure, he says one of the best ways to find out is to join a local YMCA or community center, which often provides access to basketball courts, a swimming pool and group activities ranging from volleyball to tai chi.

Swanson says it is a decision facing more and more baby boomers, who are much more active than prior generations of senior citizens. 

“Baby boomers do not want to retire and just sit around,” Swanson says. “They want to travel and hike and remain active. The days of somebody wanting to retire to an easy chair and just watch sports all day — those are gone.”