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Deadly Melanoma: Best Prevention, Detection and Treatment Breakthroughs

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A simple step can reduce deaths by 60% (and it’s not sunscreen)

Melanoma is the most dangerous form of skin cancer. It’s particularly frightening because it’s more likely than other cancers to spread (metastasize) to other parts of the body. More than 76,000 Americans are diagnosed with melanoma each year, and between 8,000 and 9,000 will die from it.

Good news: New technology increases the chances that a melanoma will be detected early—and when it is, you have a 95% to 97% chance of surviving. The prognosis is worse after the disease has spread. However, therapy has been revolutionized to extend survival times,  particularly in the last two years.

WHO’S AT RISK?

A study published in Journal of Investigative Dermatology found that melanoma rates increased by 3.1% annually between 1992 and 2004—and the incidence continues to rise.

The increase is due to several reasons. The US population is aging, and older adults are more likely to get melanoma (though it is a leading cause of cancer death in young adults). Public-awareness campaigns have increased the rate of cancer screenings (though officials would like the screening rates to be even higher), and more screenings mean an increase in melanoma diagnoses.

If you are a fair-skinned Caucasian, your lifetime risk of getting melanoma is about one in 50. The risk is lower among African Americans, Hispanics (although over the past decade incidence has increased 20% among Hispanics) and Asians, but they’re more likely to die from it. Reason: They often develop cancers on “hidden” areas (such as the soles of the feet), where skin changes aren’t readily apparent.

Important: Don’t be complacent just because you avoid the sun or use sunscreen. Many cancers appear in areas that aren’t exposed to the sun, such as between the toes or around the anus.

STATE-OF-THE-ART SCREENING

Melanomas grow slowly. Patients who get an annual skin checkup are more likely to get an early diagnosis than those who see a doctor only when a mole or skin change is clearly abnormal.

Doctors used to depend on their eyes (and sometimes a magnifying glass) to examine suspicious areas. But eyes-only examinations can identify melanomas only about 60% of the time.

Better: An exam called epiluminescence microscopy. The doctor takes photographs of large areas of skin. Then he/she uses a device that magnifies suspicious areas in the photos. The accuracy of detecting melanomas with this technique is about 90%.

The technology also allows doctors to look for particular changes, such as certain colors or a streaked or globular appearance, that indicate whether a skin change is malignant or benign. This can reduce unnecessary biopsies.

Few private-practice physicians can afford the equipment that’s used for these exams. You might want to get your checkups at a medical center or dermatology practice that specializes in early melanoma detection. If this isn’t possible, ask your doctor if he/she uses a handheld dermatoscope. It’s a less expensive device that’s still superior to the unaided eye.

NEW TREATMENTS

In the last few years, the FDA has approved several medications for patients with late-stage melanoma. These drugs don’t cure the disease but can help patients live longer.

Ipilimumab (Yervoy) is a biologic medication, a type of synthetic antibody that blocks a cellular “switch” that turns off the body’s ability to fight cancer. A study of 676 patients with late-stage melanoma found that those who took the drug survived, on average, for 10 months after starting treatment, compared with 6.4 months for those in a control group.

Vemurafenib (Zelboraf) may double the survival time of patients with advanced melanoma. It works by targeting a mutation in the BRAF V600E gene, which is present in about 50% of melanoma patients. Researchers who conducted a study published in The New England Journal of Medicine found that more than half of patients who took the medication had at least a 30% reduction in tumor size. In about one-third of patients, the medication slowed or stopped the progression of the cancer.

Combination treatment. Each of these medications attacks tumors in different ways. They can be used in tandem for better results. Drugs such as Yervoy and two additional newly approved drugs, nivolumab (Opdivo) and pembrolizumab (Keytruda), have been shown to work in combination with each other, affording much more effective therapy and giving new hope to melanoma patients. Also, new developments in vaccine therapy offer promise for the future, but are not FDA-approved at this time.

Both drugs can have serious side effects. For now, they’re recommended only for a select group of patients.

SELF-PROTECTION

Take steps to protect yourself…

Check your skin monthly. It’s been estimated that deaths from melanoma could be reduced by 60% if everyone would do a monthly skin exam to look for suspicious changes. Look for asymmetric moles in which one part is distinctly different from the other part…moles with an irregular border…color variations…a diameter greater than 6 millimeters (mm), about one-quarter inch…or changes in appearance over time.

Get a yearly checkup with a dermatologist. It’s nearly impossible to self-inspect all of the areas on your body where melanoma can appear. I advise patients to see a dermatologist every year for full-body mapping. The doctor will make a note (or photograph) of every suspicious area and track the areas over time.

Important: New moles rarely appear in people over the age of 40. A mole that appears in patients 40 years and older is assumed to be cancer until tests show otherwise.

Use a lot of sunscreen. Even though melanoma isn’t caused only by sun exposure, don’t get careless. Apply a sunscreen with an SPF of at least 30 whenever you go outdoors. Use a lot of sunscreen—it takes about two ounces of sunscreen (about the amount in a shot glass) to protect against skin cancer. Reapply it about every two hours or immediately after getting out of the water.

Don’t use tanning salons. Researchers who published a study in Journal of the National Cancer Institute found that people who got their tans at tanning salons—that use tanning lamps and tanning beds that emit UV radiation—at least once a month were 55% more likely to develop a malignant melanoma than those who didn’t artificially tan.

For more information about how you can prevent skin cancer, read Bottom Line’s Guide to Skin Cancer: Prevention, Detection and Treatment.

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Source: The late Albert Lefkovits, MD, an associate clinical professor of dermatology at Mount Sinai School of Medicine and codirector of the Mount Sinai Dermatological Cosmetic Surgery Program, both in New York City. He is a member of the Medical Advisory Council of The Skin Cancer Foundation, a member of the Melanoma and Skin Cancer Committee of the American Academy of Dermatology and a past-president of the Dermatology Society of Greater New York. He also is a reviewer of The Medical Letter. Publication: Bottom Line Personal
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