Advances in cancer treatment produce encouraging results for melanoma patients

For the Gazette
Thursday, June 07, 2018

June is always a good month in this part of the world to remind folks of the year-round importance of sunscreen for everyone.

It is also a good month to remember to do regular body checks for any unusual skin spots or skin growths that increase in size.

Sometimes a partner can help with this check. There is also the option to ask one’s primary care provider to do it during a regular visit. It means getting into one of those unfashionable johnny gowns for a full head-to-toe skin check, but as any good article on cancer prevention reminds — the earlier a malignancy is caught, the more effective the treatment.

Skin cancer, which starts in the skin’s outer layer and is the most commonly diagnosed form of cancer, is no different.

This is something primary care providers should be more aware of during annual well visits.

Skin cancer is often associated with aging, sun damaged skin but we have begun to see more younger adults with a diagnosis of melanoma, the deadliest form of skin cancer.

It is now said to be the third most common cancer among women ages 20 to 39 and the second most common cancer in men ages 20 to 39.

Epidemiologists are concerned to know what factors may be behind this increase. There is the behavior aspect — young people do like to spend as much time in the sun as possible despite what we know of the harm from the sun’s ultraviolet rays or exposure through UV tanning beds.

There is concern that there may be other environmental or genetic factors involved. Also, the increase raises the question as to whether melanoma in an older person is the same as that in a younger patient.

Surgical oncologists like me with two decades of experience have seen great advances in cancer treatments.

The first line of treatment with melanoma of the skin is generally surgery. This determines whether it has spread and helps define further treatment.

The vast majority of surgical treatments with melanoma are out-patient based. It is not overly taxing which is especially good for older patients. A sentinel lymph- node biopsy will be done to tell whether it has spread to the lymph nodes or imaging will be ordered to see if it has spread to other organs.

Melanoma can be difficult to distinguish from normal pigmented cells which are everywhere in our body — in our lymph nodes, behind our eyes, in the lining of our colon. It takes expertise (many times involving a dermatopathologist or skin pathologist) and sophisticated testing to assess the pathology.

Today’s technology has progressed with the identification of certain genetic markers to help with determining the point at which atypical cells become melanoma and require treatment.

Immunotherapy has advanced the treatment for melanoma as well as for other cancers. Science is capable of altering the body’s immune system through the discovery of checkpoints — think of these as switches in one’s immune system. The immunotherapy is designed to turn these switches — which somehow get turned off in the presence of cancer — back on to attack melanoma or other cancer. The hope is that this will continue to happen even after the treatment has been discontinued, which could lead to a cure.

This is revolutionary compared to 20 years ago when we had one class of immunotherapy drugs — interferon — to treat invasive melanoma and a limited choice of chemotherapy drugs. Today’s immunotherapy drugs with their ability to alter the immune system are now able to provide patients who have the most advanced stages of melanoma a complete response by allowing them to be free of disease.

We know much more in 2018 than we did in the 1940s about how the sun’s ultraviolet rays prematurely age and cause damage to skin and pigment cells and how this can lead to cancer.

This is why it is so important to avoid tanning and UV tanning beds, to wear sunglasses and other protective coverings like hats, and to use a broad-spectrum sunscreen.

Fair-skinned people, those with a lot of moles, and still others who have had sunburns are particularly at risk. Doing regular skin checks, however, is an important routine for everyone.

Dr. Richard B. Arenas is chief of surgical oncology, Baystate Medical Center, Baystate Regional Cancer Program. He is among the Baystate health professionals who contribute a column about cancer to this space on a monthly basis.