Immunotherapy for Melanoma

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Melanoma is by far the deadliest skin cancer but recent advances in cancer treatment have significantly improved the prognosis.  More than one million Americans are living with melanoma. It is estimated that 91,270 invasive melanoma cases will be diagnosed in 2018, with invasive melanoma projected to become the fifth most common cancer in men and the sixth most common cancer in women in 2018.[1]

Melanoma is more likely than most cancers to spread to the brain, and once it gets there, fewer than 20 percent of patients survive within one year with traditional treatments.[2]  However, newer options utilizing the body’s own immune system hold promise for helping patients with advanced-stage melanoma.  You may have read about the recent Nobel Prize winner, Jim Allison from MD Anderson Cancer Center.  His discoveries laid the ground-work for a life-saving new treatment for melanoma.

Immunotherapy works by harnessing the body’s own immune system to recognize and destroy cancer cells more effectively. Within our immune system, there are regulatory molecules called immune checkpoints, which work to keep the immune system in a balanced state (homeostasis). Tumors from cancers like melanoma take advantage of this regulatory mechanism to avoid being eliminated by the immune system. [3]

A specific group of immunotherapy drugs, called checkpoint inhibitors, work by inhibiting these immune checkpoints to release the brakes and unleash a much stronger immune response to the tumor. While these drugs do not help everyone, they have demonstrated excellent results thus far and are an important part of the initial treatment plan for patients with advanced melanoma.

 

 

[1] American Academy of Dermatology. Skin Cancer; Incidence Rates. Available online at: https://www.aad.org/media/stats/conditions/skin-cancer.
[2] Grady, Denise (Aug 22, 2018). Immunotherapy Drugs Slow Skin Cancer That Has Spread To The Brain. The New York Times; A16.
[3] Grady, Denise (Aug 22, 2018). Immunotherapy Drugs Slow Skin Cancer That Has Spread To The Brain. The New York Times; A16.

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Test your skin cancer IQ

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Skin cancer is the most common cancer in the United States, and it is estimated that one in five Americans will develop this condition in their lifetime. Skin cancer is triggered by mutations or defects in DNA, leading to cells growing out of control to form malignant tumors.

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A Breakthrough In Melanoma Detection

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Are you reluctant to undergo a skin biopsy because of the potential for a scar? We have good news. There is a new, non-invasive melanoma detection method to check suspicious dark moles. Read the story below by Dr. Maral Skelsey and learn more about DermTech, a “bladeless biopsy.”

Catch More, Cut Less. A Breakthrough In Melanoma Detection

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Amelanotic Melanoma: Symptoms, Causes, Treatment

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melanomaA patient recently came to the office concerned about a new dark mole on her leg. During her full body skin examination, I noticed a pink bump on her back.  I asked her about it and she said it was a bug bite that was taking a long time to heal.  Because of the appearance of the lesion when I examined it with a dermatoscope, I recommended a biopsy. Unfortunately, the pink spot on her back turned out to be a melanoma. The mole on her leg was benign.

 

Most patients are concerned when they spot a new dark mole, but it’s not widely recognized that melanoma can present as a pink or colorless skin lesion. Amelanotic melanoma is a serious form of skin cancer where the cells do not make melanin or pigment. It is responsible for approximately 2-20% of melanoma cases1. Because of their lack of color, diagnosis of this type of melanoma may be delayed until it reaches an advanced stage.

Symptoms

One of the most obvious symptoms of amelanotic melanoma is the sudden appearance of a red, pink, or skin-colored spot on your body where it wasn’t before. Melanomas also grow and may change shape, becoming a larger bump over time. Amelanotic melanoma may not present with the classic ABCD criteria (Asymmetry, Border Irregularity, Color variation, and Large Diameter) that are typically associated with melanoma warning signs. Expanding the ABCD warning signs to include the 3 Rs (Red, Raised, Recent change) may help in the early detection of amelanotic melanoma2. It is also estimated that about 25% of melanomas of the nail are amelanotic, so checking your nails should be a regular part of self-skin examinations. It is important to note that melanoma may present differently in individuals of color, therefore regular self-skin examinations are essential in the early detection of these skin cancers.

Causes

Melanoma occurs when the DNA in your skin cells becomes damaged, which can cause the cells to grow out of control and become cancerous. Exposure to the sun for long periods of time can damage your skin cells and increase your risk for melanoma. This risk is increased in patients with fairer skin, individuals of European descent, those with many moles (especially 50 or more), a family history of melanoma, and patients with a weakened immune system from an existing condition3. The use of tanning beds has also been associated with an increased risk for melanoma and should be avoided4.

Treatment

The most common treatment for melanoma is surgical removal.  However, melanoma can spread to the lymph nodes, necessitating the removal of one or more nodes. Advanced melanoma may need to be treated with chemotherapy and/or radiation. Biological therapy (or drugs that aid your immune system in killing cancer cells) as well as targeted therapy (medications that weaken cancer cells) are other common melanoma therapies. Patients with a history of a previous melanoma are 4 times more likely than the general population to develop a subsequent invasive melanoma, therefore full body skin examinations should be performed by a dermatologist every 3 months after a melanoma diagnosis.

 

References:
1.         Thomas, N.E., Kricker, A., & Waxweiler, W. Comparison of Clinicopathologic Features and Survival of Histopathologically Amelanotic and Pigmented Melanomas: A Population-Based Study. JAMA Dermatol. 2014;150(12):1306-1314. doi:10.1001/jamadermatol.2014.1348
2.         Kim, S.J., Park, H.J., Lee, J.Y., Cho, B.K., A Case of Subungual Melanoma. Ann Dermatol. 2008 Mar; 20(1): 26–28. Published online 2008 Mar 31. doi:  10.5021/ad.2008.20.1.26
3.         American Cancer Society. Risk Factors for Melanoma Skin Cancer. Available online at: https://www.cancer.org/cancer/melanoma-skin-cancer/causes-risks-prevention/risk-factors.html
4.         American Academy of Dermatology. Indoor Tanning. Available online at: https://www.aad.org/media/stats/prevention-and-care

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SKIN CHECK AT AUSTRALIAN EMBASSY

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Dr. Skelsey and her team were invited to take part in a sun safety program at the Australian Embassy on June 3 where Sid the Seagull, the famous mascot of Australia’s Sun Smart campaign, entertained Embassy families and reminded everyone to “Slip, Slop, Slap, Seek and Slide” to protect against skin cancer. Sid-Event-postersDr Skelsey and her team provided skin cancer screenings as well as gift bags with some of the latest and best sun screens, sun glasses and UV bracelets.

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THE WASHINGTON BALLET IS ON ITS TOES WHEN IT COMES TO SKIN CANCER…

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Dr.-Skelsey-Ballet-examines-armOn Friday, May 6, 2016, The Washington Ballet took a proactive approach to keeping its performers healthy by offering skin cancer screenings. Dr. Skelsey, who is a member of The Washington Ballet Board of Directors, performed the highly recommended, annual full body skin cancer screening on the dancers and other members of the ballet company utilizing new, state of the art, non-invasive, diagnostic technology, DermTech®. A simple adhesive patch is used to detect the presence of cancer in suspicious lesions.

The new Washington Ballet Health and Wellness Fund is committed to making services available to its dancers that protects their health, safety and wellbeing. Under the auspices of the health and Wellness Fund Dr. Maral Skelsey, a member of TWB board of directors, provided skin cancer screenings for the company during Melanoma Awareness Month in May.

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BATTLING SKIN CANCER IN A HIGH RISK POPULATION

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The Dermatologic Surgery Center of Washington helps to battle skin cancer in one of the world’s most vulnerable populations. Each year Dr. Skelsey and her staff volunteer at the Australian Embassy Health Fair where they do skin cancer screenings for embassy personnel.

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Australia and New Zealand have one of the highest incidence and mortality rates of melanoma in the world, according to Australia’s Department of Health and Aging. Fair-skinned populations that migrated from Britain and Europe to areas with high levels of solar ultraviolet radiation like Australia and New Zealand, have experienced a jump in the incidence of both melanoma and non-melanoma skin cancers.*
This year Physician’s Assistant Cynthia Wallace performed more than 30 full body scans at the October 30 fair.

Australians battle skin cancer on their own turf with ongoing research and a preventative program worth noting here in the US: Australian researchers recently released a study abstract revealing that Nicotinamide, a form of vitamin B3, significantly reduces the incidence of nonmelanoma skin cancers among people who have had a previous basal cell carcinoma or squamous cell carcinoma.

One of the most successful health campaigns in Australia’s history was launched by Cancer Council Australia in 1980. Sid the seagull, wearing board shorts, t-shirt and a hat, tap-danced his way across TV screens singing a catchy jingle to remind viewers of three easy ways of protecting against skin cancer.

Slip, Slop, Slap! It sounds like a breeze when you say it like that Slip, Slop, Slap! In the sun we always say “Slip Slop Slap!” Slip, Slop, Slap! Slip on a shirt, slop on sunscreen and slap on a hat, Slip, Slop, Slap! You can stop skin cancer – say: “Slip, Slop, Slap!”

*National Centre for Epidemiology and Population Health at the Australian National University

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CANCER IN MINORITIES ON PBS

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Don’t miss Dr. Maral Skelsey, Mohs surgeon on the PBS Vocal Point special “Cancer in Minorities” which airs on WHUT TV.

  • Thursday, September 24 at 8:30 AM
  • Saturday September 27 at 8:00 AM
  • Monday, September 28 at 8:30 AM
  • Thursday, October 1 at 9:00PM

Please check your local TV listings for the channel in your area.
Maral Kibarian Skelsey, MD, is Director of the Dermatologic Surgery Center of Washington in Chevy Chase, Maryland, which specializes in Mohs Surgery. Dr. Skelsey also serves as Director of Dermatologic Surgery at Georgetown University Medical Center and is Clinical Associate Professor of Dermatology at Georgetown University School of Medicine.

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GEORGETOWN’S TREND SETTING IZZY SALON JOINS FRONT LINE BATTLING SKIN CANCER

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Dr-Maral-Skelsey-Isabelle-Goetz,-The hair stylists of the Izzy Salon in Georgetown recently participated in a Skin Cancer Foundation skin cancer awareness program presented by Maral Kibarian Skelsey, MD, Washington, DC skin cancer specialist and MOHS surgeon. The ‘Heads Up’ program encourages dermatologists and beauty professionals to partner to help battle the US skin cancer epidemic.

According to The Skin Cancer Foundation, each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon. In January 2015 the Centers for Disease Control reported that the cost of treating skin cancer outpaced treatment costs for all other cancers combined by 5-fold from 2002 to 2011.

Izzy Salon owner, Isabelle Goetz, says she supports the program because her stylists regularly see areas of the skin, the scalp, ears and necks that clients don’t see. She adds that her clients also tend to be very busy people and probably would not notice a possible cancer. “In fact, several of our stylists have taken it upon themselves to suggest that a client see a dermatologist,” says Ms. Goetz “The program is saving lives,” adds Dr. Skelsey who is medical director of the Dermatologic Surgery Center of Washington in Chevy Chase, Maryland. “I’ve had several referrals from hair stylists. One patient had an advanced melanoma on her scalp that she was totally unaware of. The referral saved her from a life threatening situation.”

Dr. Skelsey also serves as Director of Dermatologic Surgery at Georgetown University Medical Center and is clinical associate professor of dermatology at Georgetown University School of Medicine. World renowned Isabelle Goetz Celebrity Hairstylist was professionally trained in France, then in 1993 Isabelle was recruited to work in the United States. Through more than two decades cutting and styling hair, Isabelle has earned a stellar reputation with devoted high profile political clientele and celebrities alike.

The ‘Heads Up’ program is free to interested salons. Please contact Adrienne Cea at the Skin Cancer Foundation at 212-725-5176 x114 or by email at acea@skincancer.org.