Skin cancer is a brutal disease that will affect 1 in 5 Americans in their lifetime. There are different types of skin cancer, and although it doesn’t make up the largest number of cancer cases in the U.S., melanoma is by far the most deadly. According to the American Academy of Dermatology, non-melanoma skin cancers, in particular basal cell carcinoma and squamous cell carcinoma, impact 3 million people in the United States a year. Melanoma affects 1 million. These numbers are staggering, and at least 20 people a day die from melanoma. The number of diagnoses have gone up greatly, and with it, corresponding mortality. But not everything is bad news – early detection and cutting edge treatment are saving lives.
What Is Melanoma Exactly
Melanoma is usually, but not always, a disease of the skin. As noted by the Melanoma Research Foundation, melanoma starts in the melanocytes. These are the cells that give color to skin, eyes and hair, as well as moles and freckles. When damage occurs to the DNA of those cells, cancer grows and spreads. If not caught early and treated effectively, it can be deadly. There are three types of melanoma:
- Cutaneous Melanoma is melanoma of the skin. Since most pigment cells are found in the skin, cutaneous melanoma is the most common type. There are a few different types of cutaneous melanoma:
- Superficial Spreading Melanoma
- Nodular Melanoma
- Acral Lentiginous Melanoma
- Lentigo Maligna Melanoma
- Desmoplastic Melanoma
- Mucosal Melanoma can occur in any mucous membrane of the body, including the nasal passages, throat, vagina, anus, or in the mouth
- Ocular Melanoma, also known as uveal melanoma or choroidal melanoma, is a rare form of melanoma that occurs in the eye. Conjunctival melanoma may also be included in this category.
In short, when the pigment-producing cells in the body turn cancerous, it is a case of melanoma. Asymmetrical moles are one of the most apparent indicators of possible melanoma. (Source).
By the Numbers: Stats and Facts on Melanoma
Taken straight from the American Academy of Dermatology, the following statistics and facts demonstrate why everyone working in dermatology, cosmetic surgery, or other aesthetic clinics and/or spas, should be aware of melanoma. This will help you help your patients and clients, and may well save their lives. Here are some real facts:
- 192,310 new cases of melanoma, 95,830 noninvasive (in situ) and 96,480 invasive, will be diagnosed in the U.S. in 2019. Invasive melanoma is projected to be the fifth most common cancer for both men (57,220 cases) and women (39,260 cases) in 2019. Melanoma rates in the United States doubled from 1982 to 2011 and have continued to increase since
- Caucasians and men older than 50 have a higher risk of developing melanoma than the general population. The incidence in men ages 80 and older is three times higher than women of the same age. The annual incidence rate of melanoma in non-Hispanic Caucasians is 26 per 100,000, compared to 4 per 100,000 in Hispanics and 1 per 100,000 in African-Americans.
- Skin cancer in patients with skin of color is often diagnosed in its later stages, when it’s more difficult to treat. Research has shown that patients with skin of color are less likely than Caucasian patients to survive melanoma. Twenty-four percent of melanoma cases in African-American patients are diagnosed at the regional stage, while 16 percent are diagnosed at the distant stage. People with skin of color are prone to skin cancer in areas that aren’t commonly exposed to the sun, like the palms of the hands, the soles of the feet, the groin and the inside of the mouth. They also may develop melanoma under their nails.
- Before age 50, melanoma incidence rates are higher in women than in men; however, rates in men are twice as high by age 65 and three times as high by age 80. It is estimated that melanoma will affect 1 in 27 men and 1 in 40 women in their lifetime. Melanoma is the second most common form of cancer in females age 15-29. Melanoma incidence is increasing faster in females age 15-29 than in males of the same age group. Research indicates that the incidence of melanoma in women 18-39 increased 800 percent from 1970 to 2009. Melanoma in Caucasian women younger than 44 has increased 6.1 percent annually, which may reflect recent trends in indoor tanning.
- The majority of melanoma cases are attributable to UV exposure. Increasing intermittent sun exposure in childhood and during one’s lifetime is associated with an increased risk of squamous cell carcinoma, basal cell carcinoma and melanoma. Research suggests that regular sunscreen use reduces melanoma risk. Higher melanoma rates among men may be due in part to lower rates of sun protection. Even one blistering sunburn during childhood or adolescence can nearly double a person’s chance of developing melanoma. Experiencing five or more blistering sunburns between ages 15 and 20 increases one’s melanoma risk by 80 percent and nonmelanoma skin cancer risk by 68 percent. Exposure to tanning beds increases the risk of melanoma, especially in women 45 and younger. Researchers estimate that indoor tanning may cause upwards of 400,000 cases of skin cancer in the U.S. each year.
- Risk factors for all types of skin cancer include skin that burns easily; blond or red hair; a history of excessive sun exposure, including sunburns; tanning bed use; a weakened immune system; and a history of skin cancer. People with more than 50 moles, atypical moles or large moles are at an increased risk of developing melanoma, as are sun-sensitive individuals (e.g., those who sunburn easily, or have natural blond or red hair) and those with a personal or family history of melanoma.
Unfortunately, survivors of melanoma have almost a 10 times greater chance than non-melanoma survivors of getting another melanoma. That said, if you have a patient or client that has melanoma, is at risk of melanoma, or has warning signs of it, assure them that there is an answer.
Treatment for Melanoma
Today the biggest promise for beating melanoma lies with immunotherapy.
As defined by the American Cancer Society, “Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively.” There are a number of medications that are coming to market that promise spectacular results, and a handful that have been showing great promise of helping most patients. They fall into a number of categories: PD-1 inhibitors, CLTA-4 inhibitors, Cytokines, Oncolytic Virus Therapy, BCG Vaccine, Imiquimod Cream, and other new and emerging treatments. While there are currently any number of research projects on these potential new treatments, the Melanoma Research Alliance reports that:
Researchers are actively working to create targeted therapies that last longer and work for more patients. One way researchers have found success is by combining a BRAF inhibitor with a MEK inhibitor – such as the FDA-approved dabrafenib + mekinist or vemurafenib + cobimetinib. The combined therapy works better, for longer, and with fewer serious side effects than either drug on its own. Researchers are working to find additional targets in order to create new combinations. Key to doing this is finding additional mutations that future drugs can be aimed at. Drugs targeting mutations in the NRAS protein are an important area being studied in clinical trials. Researchers are also examining if intermittent dosing – one week on and one week off (or some other schedule) – is effective at stopping or at least slowing targeted therapy resistance.
More information about these drugs will be available at SCALE 2019 Music City, and many of the drug vendors will be there to answer your questions.