An Overview of Melanoma and Skin Cancer - symptoms, causes and treatment alternatives

An Overview of Melanoma and Skin Cancer - symptoms, causes and treatment alternatives

Information on Melanoma and Skin Cancer - symptoms, causes and alternative therapies; 

This overview on melanoma and skin cancer and its associated articles will give you everything you need to know to help you increase your personal odds of beating the cancer - the symptoms, the diagnosis, the causes and all the latest options on cancer treatments - from cancer drugs and chemotherapy to surgery, radiotherapy, immunotherapy and the very latest alternative cancer treatments and new cancer therapies. (This article has been compiled by  Chris Woollams from worldwide research and expert sources.)

Skin cancer and melanoma - myths and realities

Skin cancer is statistically the fastest growing cancer in Britain. But many of the historic beliefs on the disease are turning out to be nonsense. This article looks at the evidence; the facts. 

Perhaps the most important place to start is with the misinformation and fear-mongering that sunshine is bad for you. For example, melanoma cells have a large number of receptor sites on their surface for vitamin D. Yes, that's right. The sunshine vitamin (which is actually a hormone) potentially 'corrects' the melanoma cell. Is it any surprise that one study in the UK showed that 93% of melanoma patients on diagnosis were severely DEFICIENT in the sunshine vitamin?!

By the time you have read this overview we doubt you will believe that the best way to beat skin cancer and melanoma is to 'Slip, slop, slap', with all that suncream rubbed on your skin every hour? Professor Michael Holick along with colleagues who have researched vitamin D extensively, believes that sunscreens should have a warning label on them as being bad for your health!

We want you to stay safe in the sun, whilst allowing it to improve your overall health and well-being. So, if you have a moment, learn the Truth about what you should really do in the sun to prevent skin cancer and melanoma:

Go to: The CANCERactive SafeSun Campaign

 

Volume 1, Issue 12 coverThe Truth about Skin Cancer and Melanoma

Back in 2007 there were approximately 275,000 people diagnosed with cancer in the UK. Curiously though, one cancer was not even included in these official figures: Skin Cancer. The view was that the vast majority of non-melanoma skin cancers were simple to treat by primary care and there was no need for an oncologist to intervene; so, the data was just not collected! 

But, supposedly, this was even then the UK's fastest growing cancer in terms of numbers of people diagnosed and the largest single cancer at about 40,000 cases overall. Back in 2007 there were about 7,500 melanoma cases in the figures.

Fast forward to 2018 and this has changed. Now we have 360,000 cases of cancer last year in the UK. Still not included are 142,000 cases of skin cancer and about 16,000 cases of melanoma. That makes skin cancer the number 1 cancer in the UK; and melanoma about 5th. But, put against this the number of deaths and you have a very different picture. Just 1300 people died last year from skin cancer, and 2,285 from melanoma, making these two cancers seemingly rampant, yet providing the lowest death to diagnosis rates of any cancer. What's going on?

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Greater awareness means more diagnosis

It's simple. Such was the scare-mongering, that more doctors looked for early signs of skin cancer and melanoma, and found more suspicious issues, and treated them! According to a 2012 report in The British Journal of Dermatology, many early skin lesions are now being called skin cancer or melanoma. Indeed, while the levels of melanoma seem to have doubled in the past decade, the levels of stage 2 to stage 4 melanoma have not increased at all. All the increase has come from stage 1 lesions. The report calls it 'diagnostic drift' In other words, people are being diagnosed as having potentially serious melanoma when the tag is not warranted. Melanoma has even gone through a name change - all cases are now dubbed 'Malignant Melanoma'. Ordinary skin cancer is now dubbed 'Non-Melanoma Skin Cancer'. The spread-risk threat has been increased in people's minds, although in reality, there's little that has worsened.

Over half of melanoma issues occurs in places where the sun don't shine

Equally important was that the majority of these early lesions seem to have little to do with sun damage. The same report goes on to conclude 'most of these stage 1 lesions have nothing to do with the sun'. 

But then, we are not surprised - we have been telling you for years that blaming the sun alone for skin cancer is wrong. As was the worldwide Sunsmart campaign! (This is why we launched our own Safe Sun campaign). Being 'smart' about the sun is making sure you go in it - sensibly. Sunshine on the skin increases vitamin D levels which REDUCE the risk of cancer, Alzheimer's, heart disease, diabetes, gut problems, MS - the list is endless.

And that goes for people with melanoma too. 93% of people on diagnosis with melanoma have dangerously low vitamin D levels at around 15-20 ng/ml, according to research from St George's Hospital, London. These people have not had enough sunshine! And lowered vitamin D levels are linked with increased risk of cancer. According to Boston Medical School, healthy plasma levels should be between 75nmol/L and 150 nmol/L

Causes of skin cancer and melanoma?

1. Good Vitamin D levels are essential: Vitamin D is important in preventing cancer because it can correct cancer cells, limit inflammation in the gut (which reduces it in the body) and because vitamin D molecules arm the immune system's T-cells. Without vitamin D they cannot attack cancer cells in the body.

Go to: Vitamin D - are you getting enough?

2. Burning is bad for you: All the major charities talk about over-exposure to the sun as the cause; but it is very rare that there is just one cause of a cancer. And, there are several research studies over the last few years that show people who regularly get exposure to sunshine have LESS skin cancer.. 

The issue isn't sunshine; it's burning

Burning is the issue, and may be one possible contributory factor to the formation process. For example, people with malignant melanoma are more than three times as likely to have been badly sunburned several times in their lives as those without the disease. The issue isn't sunshine per se; it is sudden exposure of white skin to the sun and burning.

One Australian study found that going all-out for a tan on a fortnight's holiday is more risky than working constantly outdoors. 

One major reason for skin cancer's dramatic increase in the UK is our increasing desire to jet off for a sun holiday in the middle of winter. So we expose pale skins to tropical sun for 10 days, and then cover them up again for 4 months - and we think its doing us good. It takes at least 4 days for your natural pigmentation to develop. Before that you can easily burn.

Another issue is that many people think that sun cream usage gives them a licence to stay in the sun for longer. And apparently, many people use a sun 'factor' too weak for the job.

Research from Professor Saunders of Mount Vernon Hospital has shown that sunscreen has an SPF rating that relates to UVB and burning. But UVA is now known to penetrate deeper and cause the DNA changes. The three top sunscreens were found to be deficient in UVA protection.

3. Oestrogen (estrogen) has been shown on multiple occasions to play a role in melanoma. For example, a study in the 2012 issue of 'Cancer Prevention Research' showed that, in a sample of 7,360 women, those who were on anti-estrogen treatments had a 60% lowered risk of melanoma. Melanoma has an estrogen-binding receptor. Anti-estrogen treatments have also been linked to lower recurrence. Interestingly men seem to have more estrogen receptor sites in their melanoma cells and women with melanoma have a better prognosis than men. Also the skin seems to possess its own hormonal environment. Factors such as these and more, can be found in a review of the effects of oestrogen in melanoma progression

Another study showed that a woman on the estrogen contraceptive pill had a higher risk of skin cancer. 

Now, herein lies an inconvenient truth. Sunscreen, 'After sun' and 'sunburn creams' often contain chemicals that are known to be xenoestrogens (chemicals that once in the body, mimic the action of estrogen). Certain ingredients like PABA have been banned in Scandinavia after just such fears. Other ingredients like oxybenzone are so hormone-changing they are feminising the fish off the Californian coast. A new concern is retinyl palmitate which is a synthetic cousin of vitamin A and is often present in all manner of skin creams, sun creams, aftersuns etc. There are concerns in research with the FDA right now. The bottles contain plasticisers. Leave them in the sun and they leach xenoestrogen like BPA and phthalates into the contents, as Johns Hopkins showed, and cancer charities encourage you to rub sunscreen on your skin repeatedly every hour!

Worse, some chemicals which are tested only in laboratories, become carcinogenic under the effects of sunlight, 

Perfumes, body washes, shower gels and shampoos contain xenoestrogens.

Being overweight and having fat stores are both linked to increased levels of estrogen in the body.

Go to: 10 ways to cut your estrogen levels naturally

4. Pilots and cabin crews have double the risk of melanoma: There are a number of studies and a meta-analysis. Is it the UVA exposure, or the cosmic rays, or the disturbed sleep patterns which reduce melatonin, the hormone that controls your oestrogen in your body? Perhaps it's a combination of all three. People who have disturbed sleep patterns get more estrogen-driven cancers like breast cancer and prostate cancer. 

5. Melanoma is, linked to the presence of moles. People with a lot of moles can have them routinely checked. A common mole is where pigment cells (melanocytes) grow in clusters. It is now known that some types of mole have a higher risk of turning cancerous. (A dysplastic nevus is a larger, flatter type of mole which may have several colours - from pink to red to brown. Unlike common moles they have irregular edges). If you do develop a melanoma in a mole, the mole can be easily removed. Usually, research shows only if the mole is deep is there actually a risk of malignancy and recurrence. The formation of metastases in melanoma (e.g. in nearby lymph nodes) is rarely observed in Stage 1 and 2 melanoma. 

6. Gut bacteria and skin bacteria: An interesting development concerning all skin cancer is the finding that the skin has its own microbiome - that is, your skin has a bacterial make-up unique to you. The skin has trillions of bacteria, not just on the surface but under it, and these are believed to be linked to the gut microbiome. We know that the loss of commensal bacteria and an increase in pathogens in the gut is linked to cancer. Much the same may well occur in the skin. Thus not just UVB or UVA, but a hormone or any chemical put onto the skin could potentially weaken its natural defence.

If you need help putting together your melanoma-fighting programme, if you are confused by all the information, all the different treatments, why not look into a Personal Prescription with Chris Woollams. You can also read what people say about them.

Go to: Feedback on Personal Prescriptions with Chris Woollams

7. Sunlamps and sunbeds: There is now research evidence that shows the use of sunlamps or sunbeds can cause skin cancers too.

8.  Genetic issues: There is some link to genetic predisposition as well, especially in families with genes like BRCA1 and BRCA 2 where damage causes weakened DNA repair systems and weakened immune systems. There is some evidence that people who have had skin cancer have a higher risk of developing a second cancer later in life.

9.  Chemical exposure: There is some evidence that squamous cell carcinomas can occur after exposure to arsenic, toxic hydrocarbons, x-rays or even simply extreme heat. Others can occur in scar tissue. Simple immune system compromise by infection or drugs may also promote this form of skin cancer. Research has shown that marathon runners have a higher incidence of melanoma than the norm.

10.  Drug sensitivity: A number of drugs increase sensitivity to the sun. These include sulfonamide drugs, some antibiotics, some antidepressants (including tricyclic drugs and even St Johns Wort), some arthritis pain killers, some drugs for heart conditions and high blood pressure, cancer drugs and even some skin care and acne creams and lotions. You should read the labels carefully.

Types of skin cancer:

There are three main types of skin cancer.

1. Non-melanoma skin cancer

   1.1 Basal cell carcinoma where the cancer forms in the cells on the inside of the epidermis (the outer layer of your skin). This accounts for about 65 per cent of the total cases.

   1.2 Squamous cell carcinoma where the cancer is in the outer layers of the epidermis. (These cells resemble fish scales or squama). About 20 per cent of all cases.

2. Malignant Melanoma this is a completely different kettle of fish, which can form in the skin or in a mole. It doesnt simply go away when treated. Another myth is that somehow this is a rare cancer it is not. At 7,500 cases per year it is more common than ovarian cancer.

Many lesser conditions may be skin pre-cancers. For example, actinic keratosis (AK), also known as solar keratosis, is a common pre-cancer. It is a small crusty or scaly bump that occurs on or below the surface of the skin. As with cancers, it is thought to be a result of over-exposure to the sun. 

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Diagnosis of skin cancer and melanoma

Most skin cancers appear after the age of 50, although the burning may have occurred at a much earlier age. Melanoma is increasing amongst younger age groups.

The most common places for skin cancers are on the back, legs and face. Basal cell carcinomas are particularly common on the face although they can occur in areas not obviously exposed to the sun, for example in the scalp, under hair.

Basal Cell carcinomas, the most common form of skin cancer, usual start as small lumps and then gain little blood vessels. Some contain darkened melanin pigment and so give the appearance of moles. They rarely spread, although they can move deeper and outwards if left even causing problems (and disfigurement) to the eye, ear, or nose if growing nearby. They grow slowly taking months or even years to become sizable.

Diagnosis is by removal of all or part of the tissue and analysis, often simply under a microscope.

Squamous cell carcinomas are more likely to occur in light-colored skin and people with a long history of sun exposure. Men are affected more often than women. Often these growths can develop from actinic or solar keratoses, appearing years after the original sun damage on parts of the body like the cheeks and nose, as well as the backs of the hands. . It is therefore common for people who stopped being "sun worshipers" in their twenties, or for sailors and golfers in hot climates to develop such pre-cancerous  spots years later.

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Treating Skin Cancer (Non-melanoma)

Putting on suncream

Treatment for skin cancer (and pre-cancerous actinic keratoses) varies, depending on the size, type, depth and location of the lesions.

Surgery:  this can take several forms. If the cancer is small, some doctors use a spoon like instrument (a curette) to lift tissue out, sometimes using electrical current to limit bleeding. If the cancer is larger surgery may take the form of excision followed by stitching. Sometimes Cryosurgery is used where liquid nitrogen freezes the tumour to kill it - the tumour peels away as it thaws. Sometimes laser surgery will be used. Finally, a type of surgery called Mohs surgery can be used (especially in the US) where sections or layers of the tissue are removed and each examined under the microscope. This limits the amount of the healthy surrounding tissue that is needlessly removed, and is most used with large tumours.

Cosmetic surgery may be recommended. This may be performed simultaneously, or at a later stage.

Radiotherapy:  may be used in conjunction with, or instead of, surgery.

Chemotherapy:  Occasionally, topical drugs containing an anti-cancer agent may be applied. For information on your Cancer Drugs and chemotherapy click here.

Photo Dynamic Therapy:  This has also been used successfully. A photosensitive agent is applied and light shone on this agent. We have good articles on this non-toxic treatment elsewhere on the site.

Poultices and skin cancer:

An old practice dating back to the Egyptians and Greeks. Herb poultices were applied to cover the local external cancer. We have experience of a lady who applied mangosteen in concentrated form as a poultice to her cancer and it cleared up in 6 weeks, just before the orthodox surgery date planned. 

Another common treatment particularly for actinic kerotosis is Aloe Vera gel. Far better if it comes from the sap of the plant, Aloe Vera was used by Egyptians and Ancient Greeks alike. It has been known to make moles 'drop off', and counter skin cancer itself.

Another 'natural' treatment for skin cancer is Euphorbia peplus, or milkweed, or cancer weed, or radium weed, or petty spurge, which has long been used as an effective treatment for skin lesions, actinic keratosis and even skin cancer by the natives of countries such as Australia and New Zealand; it is now thought of as a natural, alternative therapy for skin cancer. The active ingredient in research is Ingenol Mebutate. In one study, patients who were either unsuitable for conventional treatment or didn't want it, were treated once daily for three consecutive days. Complete clinical response (tumor absence after clinical examination) following treatment was 82% in BCCs, 75% for SCCs, and 94% for intraepidermal carcinomas at 1 month. .

Some essential oils seem effective against skin cancer. For example there is research on Frankincense essential oil used topically on skin cancer. Frankincense is known to have anti-inflammatory and anti-cancer benefits.

Researchers at the University of Santiago, Chile, have developed an ointment from plant extracts and shown in clinical trials with animals that it is an effective treatment for skin cancer and melanoma. The herbal poultice works by increasing the visibility of the cancer cells to the immune system according to lead researcher Sofia Michelson. The ointment needs to be used every 3 days for one month. Michelson has discovered a number of herbs that can help fight skin cancer.

A first review of Botanicals and skin cancer came in 2013 (1). A number of studies some efficacy for green tea.

Controversial, but in our experience effective, is Black Salve, which has 5 ingredients each of which has powerful anti-cancer properties. There are a number of YouTube Videos where people used this poultice to beat skin cancer.

Go to: Black Salve and skin cancer

The Hoxsey Therapy,  which can be found in detail on this site, is a herbal formula and also successfully used to treat skin cancers. If caught early enough most skin cancers can be successfully treated.

Research covered in icon Cancer Watch did suggest that people who had had a skin cancer did, in subsequent years, have a higher incidence of other (unrelated) cancers than the norm. It is to be remembered that some factors like excess oestrogen can fuel the fire of skin and other cancers, and highlights the fact that a cancer appearing anywhere in the body is often a sign of weakness in the whole body.

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Melanoma treatment

Melanoma is the most dangerous form of skin cancer and its incidence is increasing. It develops in the cells that produce the pigment melanin. It can also form in the eyes  Occular Melanoma. We have articles on that cancer too.

Malignant melanoma is the most dangerous form of skin cancer

Although widely believed to be Ultra Violet induced in the body, that myth is exposed by the fact that melanoma can occur, in rare instances, in the mouth, under nails and in the intestines (Mayo Clinic).

This cancer can spread to other organs. It is most likely oestrogen-driven and really should be considered in a different light to the the vast majority of skin cancers. It is a whole body disease that usually happens to appear first on the skin surface.

Melanoma Diagnosis

Most normally melanoma involves changes to the colouration, size and/or shape of moles. But not exclusively. It can be just an unusual development on the skin. Most people have up to 50 moles, which come in all shapes and sizes. A cause for concern the larger, flatter moles with irregular edges.

The American Academy of Dermatology has developed an A-B-C-D guide for self diagnosis:

  •  A is for asymmetrical shape. Look for moles with irregular shapes, such as two very different-looking halves.
  •  B is for irregular border. Look for moles with irregular, notched or scalloped borders the characteristics of melanomas.
  •  C is for changes in color. Look for growths that have many colors or an uneven distribution of color.
  •  D is for diameter. Look for new growth in a mole larger than about 1/4 inch (6 millimeters).

Other suspicious changes in a mole may include:

  •  Scaliness
  •  Itching
  •  Change in texture for instance, becoming hard or lumpy
  •  Spreading of pigment from the mole into the surrounding skin
  •  Oozing or bleeding

Malignant moles vary greatly in appearance. Some may show all of the changes listed above, while others may have only one or two unusual characteristics. (Mayo Clinic).

Click here and read our article "What is Cancer"

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Melanoma Treatment alternatives

If the Melanoma has not spread, the treatment options are similar to those for skin cancers in general and there is a high success rate. Bear in mind that three quarters of melanoma is caught at Stage 1.

Recent research covered in Cancer Watch suggested that the depth of the infected mole was an important determinant of the danger of spread.

Melanoma will be graded in Stages 1-4 according to level of spread. Stage 2 indicates that some spread has begun, possibly to adjacent lymph nodes. When your surgeon operates he may remove these too. (After treatment you may find Lymphatic Drainage  techniques a great help).

Chemotherapy

Chemotherapy:  Where there is spread to other tissues, Chemotherapy is the favoured option.  Cisplatin, carmustine, fotemustine and paclitaxel have often been the chosen drugs, usually in combinations. Dacarbazine is believed to be the Gold Standard drug with a response of around 20 per cent. However it has encountered some recent competitive criticisms in that its effects can only hold for 6 months. The brain tumour drug Temozolomide has also produced interesting phase III trial results research in the US indicates that it is just as effective and easier to administer. Recent clinical trials in the US also indicate that Tamoxifen and Genisense each can improve response rates. The Dartmouth regime used in the USA combines dacarbazine, carmustine, cisplatin and tamoxifen. While results seemed possibly better, the side effects have been horrendous in some cases. (Chapman et al. J. Clin. Oncol 1999; 17; 2745)

Another development is the use of targeted drugs like Vemurafenib against some specific genetic change. Vemurafenib is used in advanced states, where the melanoma has spread to other organs, over half of patients seem to have a faulty BRAF gene. 

Dabrafenib and Trametinib are two others that treat advanced melanoma.

Immunotherapy and melanoma

Interferon and interleukin 2 were the first immunotherapy drugs really - they have been around a good few years and had mixed success. A new breed of biologic drugs has been founded on work with melanoma. 

Pembrolizumab is now an important drug in the fight against melanoma. Also called Keytruda, in the USA it can now be used as a first line drug. (You do not have to use other drugs first.) A trial has been looking into the use of Pembrolizumab with T-VEC. T-VEC is a genetically modified version of the Herpes simplex virus. UCLA scientists have conducted a two year study - where Keytruda doesn't work it is usually because lack a specific T-cell in their tumours (CD8+). T-VEC delivers CD8+. UCLA scientists say this combined treatment works in 68% of cases.

Then you have ipilimumab and nivolumab, two immunotherapiy drugs.

There are more such drugs, and in some cases people receive a combination of two immunotherapy drugs simultaneously.

Go to: Immunotherapy - Comprehensive Overview

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Complementary therapies, alternative therapies and Integrative therapies for melanoma.

First: Go back to the causes and you will see some basics that you should think seriously about.

1. Make sure your vitamin D levels are around 100 ng/ml. Boston Medical School suggest people with cancer should take 5,000IUs a day (that's 4 hours in the sun).

2. Ensure you have a strong gut microbiome. Kill pathogens with artemisinin; yeasts with oregano oil or caprylic acid..

3. Employ a Rainbow Diet incorporating (as it does anyway) foods like greens and beans and pulses that are strong phytoestrogens and can block or reduce the negative effects of human oestrogen and chemical oestrogen

4. Consider taking melatonin (5 mg rising to 20mg)

5. Stop putting chemicals on your skin and into your body.

6. Look at our Living proofs on this Website of people who have beaten melanoma. One of those ladies, Beata Bishop beat melanoma, having tried all the orthodox options over 25 years ago, went on to the Gerson Therapy  and is now one of the UK's leading lights in the promotion of this treatment. Gerson is also part of how Ginny Fraser beat her melanoma when she had tumours all over her body. Over a decade later, Ginny writes for CANCERactive.  Then there's Ian Dixon's e-mail to CANCERactive, They are all in our section, LIVING PROOF.

Next, understand that CANCERactive is Europe's Number 1 Integrative Cancer Charity. This website alone has more than 4,000 pages of information on it, either as articles or as news stories. We believe you can increase your personal odds of cancer survival by taking simple health-enhancing steps and adding both complementary cancer therapies and alternative cancer therapies into your mix of treatments.

For example, Hyperbaric Oxygen, curcumin, calorie restriction, melatonin, honokiol, probiotics and whole body hyperthermia have all been shown in research to make chemotherapy work better. It then kills more cells! The research is covered on this website. Surely it makes a lot of sense to use them in your personal cancer treatment programme?

Go to: How to improve your chemotherapy

We cover how to improve your radiotherapy (and reduce side-effects) too.

Go to: Improve your Radiotherapy, and reduce side-effects

We have a complete review of Immunotherapy telling you the accurate figures and what to watch out for. We tell you what is working and when two new drugs have been used, rather than one. Its a new, emerging and alternative cancer therapy, but not fully there yet!

Go to: A complete review of Immunotherapy

Then we have an article on how to improve the success of your radiotherapy (and reduce the potential side-effects) all by adding complementary therapies.Our Guidelines on Diet and Exercise can be found through this link:

Go to: CANCERactive Guidelines on Diet and exercise

Our recommended anti-cancer diet is the colourful Mediterranean Diet (with its focus on the French paradox): 

Go to: The Rainbow Diet

Like Hippocrates, we believe all cancer begins in the gut and that gut problems, yeast, viral and parasite infections are common constituents of cancer.

Go to: All cancer begins in the gut

But if you just want to look at the most comprehensive list of Complementary Therapies you can find it here:

Go to: CANCERactive Complementary and Integrative cancer therapies

And if you want alternative cancer therapies start here:

Go to: CANCERactive Alternative cancer therapies

Finally, if you want all this put together for you in one simple plan, why not look into having a Personal Prescription?

Go to: Personal Prescriptions with Chris Woollams

We dont take one penny from any Pharmaceutical company, cancer clinic or supplements company. We have no vested interest. We just want to see you beat cancer.

"If you are already thinking of supplementing with any of the above products, why not take a look at the value for money natural products in OurNatural Selection by clicking here."

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IMPORTANT INFORMATION

 

 

 *Cancer (and its related illnesses) are very serious and very individual diseases.  Readers must always consult directly with experts and specialists in the appropriate medical field before taking, or refraining from taking, any specific action.
This web site is intended to provide research-based information on cancer and its possible causes and therapies, so that you can make more informed decisions in consultation with those experts. Although our information comes from expert sources, and is most usually provided by Professors, scientists and Doctors, our easy-to-understand, jargon-free approach necessitates that journalists, not doctors, write the copy. For this reason, whilst the authors, management and staff of CANCERactive,
icon, and Health Issues have made every effort to ensure its accuracy, we assume no responsibility for any error, any omission or any consequences of an error or omission. Readers must consult directly with their personal specialists and advisors, and we cannot be held responsible for any action, or inaction, taken by readers as a result of information contained on this web site, or in any of our publications.  Any action taken or refrained from by a reader is taken entirely at the readers own instigation and, thus, own risk.

    

 

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