Skin Cancer

Annually, about 8,000 patients are found to have metastatic melanoma presenting as recurrence of an earlier primary melanoma, and this number closely approximates the annual number of deaths from the disease. This statistic illustrates the lack of progress that has been made in the treatment of stage IV melanoma over the past several decades.

Reviewing treatment modalities for melanoma provides many sobering reminders that advances in our scientific understanding have not yet translated into meaningful clinical benefit. As clearly delineated by the authors, the “standard” treatment of dacarbazine chemotherapy has a poor response rate and lacks durability.

The article by Bhatia and colleagues focuses on the treatment of patients with metastatic melanoma using standard therapies, but it also includes a brief outline of recent treatment approaches using investigational agents. In addition, the authors describe prognostic factors for metastatic melanoma, highlighting the impact of the extent of tumor and the site of metastasis (eg, soft-tissue vs visceral metastases) on survival.

Metastatic melanoma continues to be a challenging disease to treat, with an estimated 8,420 related deaths in the United States in 2008.[1] The 10- year survival rate for patients with metastatic melanoma is less than 10%.[2] More than 3 decades after its initial approval by the US Food and Drug Administration (FDA) in 1975, dacarbazine continues to be the standard of care for most patients with this disease. High-dose interleukin-2 (HD IL-2 [Proleukin]), approved by the FDA in 1998 for metastatic melanoma, benefits a small subset of patients.

The recommendation to minimize sun exposure to prevent skin cancer has produced a pandemic of vitamin D deficiency. Vitamin D has generated considerable interest in the past decade, as accumulating evidence from both retrospective and prospective epidemiologic studies suggests an association between vitamin D deficiency and increased risk of autoimmune, infectious, and cardiovascular diseases, as well as cancer.

Along with various imaging modalities, serologic tumor markers such as CA 15-3 and CA 27.29 have been used for decades to monitor treatment response in patients with metastatic breast cancer (MBC). Despite the frequent use of these markers, they lack high sensitivity and specificity for breast cancer progression. The prognostic significance of these markers remains indeterminate because of the conflicting outcome of many clinical trials. The circulating tumor cell (CTC) test has recently been studied in clinical trials in patients with MBC. Some of the studies showed that high levels of CTCs are correlated with poor survival in MBC. An intergroup trial is underway to determine the implication of changing treatment based on the CTC level. This article will discuss the current data on these markers, with special emphasis on the CTC test. The potential clinical utility of these markers will also be discussed.

University of Pittsburgh Cancer Institute researchers have discovered a previously unknown virus strongly associated with Merkel cell carcinoma, a rare but aggressive skin cancer that typically affects elderly and immunosuppressed individuals

When you inspect moles, pay special attention to their sizes, shapes, edges, and color. A handy way to remember these features is to think of the A, B, C, and D of skin cancer-asymmetry, border, color, and diameter.

Since its inception in 1985, the American Academy of Dermatology's National Melanoma/Skin Cancer Screening Program has screened more than 1.7 million people and detected more than 171,200 suspicious lesions. More than 20,000 of these lesions were suspected melanomas—the most serious form of skin cancer.

May is National Skin Cancer Awareness MonthWhat Is Your Skin Cancer IQ?Identifying BCC, SCC, and melanoma

On May 6, members of the American Academy of Dermatology (ADA) hope to set a Guinness World Record for the most people screened for skin cancer in a single day.

According to a 2005 survey conducted by the American Academy of Dermatology, 92% of the respondents understood that getting a tan from the sun is dangerous. Yet, 65% said that they think they look better when they have a tan.

Mohs surgery has been well-established as the gold standard for the treatment of BCCs and SCCs. And, as described in this article, preliminary reports suggest that it may play an equally important role in the management of several other cutaneous malignancies.

The relationship between age andmelanoma prognosis is growingmore apparent and presentsinteresting scientific and social questions.My colleagues and I publishedtwo papers analyzing melanoma patientsfrom our institution. Our firstpaper examined a population of 620patients during a 26-year period, andour most recent paper analyzed 1,018melanoma patients over 30 years.[1,2]In both of these studies, age remainedan important prognostic predictor ofdisease-free and disease-specific survivalbased on multivariate analysis(Cox proportional hazard). We alsoapplied a novel classification and regressiontree (CART) evaluation ofthe data that showed age maintaininga significant influence on disease-freesurvival. Age maintained importancein disease-specific survival when genderwas used as the first parameter tosegregate the entire patient populationbefore applying tree-structuredstatistics.

The use of radiation as adjuvant therapy for patients with cutaneousmalignant melanoma has been hindered by the unsubstantiatedbelief that melanoma cells are radioresistant. An abundance of literaturehas now demonstrated that locoregional relapse of melanoma iscommon after surgery alone when certain clinicopathologic featuresare present. Features associated with a high risk of primary tumor recurrenceinclude desmoplastic subtype, positive microscopic margins,recurrent disease, and thick primary lesions with ulceration or satellitosis.Features associated with a high risk of nodal relapse include extracapsularextension, involvement of four or more lymph nodes, lymphnodes measuring at least 3 cm, cervical lymph node location, and recurrentdisease. Numerous studies support the efficacy of adjuvant irradiationin these clinical situations. Although data in the literatureremain sparse, evidence also indicates that elective irradiation is effectivein eradicating subclinical nodal metastases after removal of theprimary melanoma. Consequently, there may be an opportunity to integrateradiotherapy into the multimodality treatment of patients at highrisk of subclinical nodal disease, particularly those with an involvedsentinel lymph node. Such patients are known to have a low rate ofadditional lymph node involvement, and thus in this group, a shortcourse of radiotherapy may be an adequate substitute for regional lymphnode dissection. This will be the topic of future research.

BOSTON-Excessive sun exposure is a known risk factor for the development of skin cancer, but sun exposure appears to have a protective effect against a variety of other cancers, according to speakers at a symposium on sunlight at the 168th National Meeting of the American Association for the Advancement of Science (AAAS).

SAN DIEGO--The results of a series of five free annual skin cancer screenings has demonstrated that community education and early detection are valuable tools in addressing cancer prevention, said Rosemary Giuliano, ARNP, MSN. She is national clinical research coordinator in the Cutaneous Oncology Program’s Department of Surgery at the H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa.

A study published in the Journal of the American Academy of Dermatology (44:807-813, 2001) reported an almost 90%

NEW YORK-Among men over age 50 with an additional melanoma risk factor, diagnostic yield of melanoma screening is 1 in 219, data from the American Academy of Dermatology (AAD) National Skin Cancer Screening Program show. That yield is high, suggesting the potential cost-effectiveness of this intervention, according to Barbara A. Gilchrest, MD, professor and chairman of dermatology, Boston University.

NEW YORK-A variety of simple dietary interventions could prove effective in inhibiting carcinogenesis and reducing the incidence of skin cancers, said James M. Spencer, MD, associate professor of dermatology, Mount Sinai School of Medicine, New York.

NEW YORK-Many persons who apply sunscreen before spending time outdoors are nevertheless increasing their risk of skin cancer by not applying sunscreen frequently enough to prevent sunburn, recent studies involving skiers at high altitudes suggest.

FREEPORT, NY-In a phase III clinical trial of 30 patients with xeroderma pigmentosum, use of a topically applied DNA repair enzyme (T4N5 liposome lotion) for 1 year reduced the incidence of basal cell carcinoma by 30% and actinic keratoses by 68%, compared with placebo.

WASHINGTON-Insufficient evidence exists to support or reject the inclusion of routine skin cancer screenings in Medicare coverage, according to a new report by the Institute of Medicine (IOM). A second IOM report urges the Health Care Financing Administration (HCFA) to end uncertainties about whether it will cover routine care for patients taking part in clinical trials by stating that it will.

A pharmaceutical treatment may offer patients an alternative to the usual surgical removal of basal cell carcinomas, according to a presentation at the annual meeting of the American Academy of Dermatology in New Orleans.

NEW YORK-Actinic keratoses should be treated or removed, according to the consensus of the American Academy of Dermatology, American Cancer Society, and Skin Cancer Foundation. “It is not merely a cosmetic issue,” said Jeffrey Callen, MD, chief of the Division of Dermatology, University of Louisville. Because of their potential to develop into skin cancer, these lesions should be regarded as a serious health problem, he said at a media briefing sponsored by the Academy as part of its Melanoma/Skin Cancer Detection and Prevention Month.

NEW YORK-The association between intermittent but intense sun exposure and malignant melanoma has long been recognized, though the reasons behind it have not been understood. Researchers have now uncovered mechanisms likely to explain why this specific pattern of sun exposure leads to the deadliest form of skin cancer.

NEW YORK-The American Academy of Dermatology has unveiled three new public service advertising campaigns targeting a broad audience with the message that prevention and early detection are the best weapons against skin cancer.

Sunscreen can help reduce the risk of malignant melanoma, contrary to the finding of a study that received considerable media

In the next 5 to 10 years, we may have the answer to the question of whether vaccines can fulfill their promise to become an effective treatment for melanoma, predict Brian J. Czerniecki, md, PhD, and Isabelle Bedrosian, md, in the latest issue of The Melanoma Letter, a publication of The Skin Cancer Foundation. These researchers are experimenting with a new kind of vaccine to combat disseminated melanoma.

Skin cancer is the most common malignancy in the United States, with approximately 1 million cases being diagnosed in 1997.[1] Of these cases, more than 40,000 will be classified as malignant melanoma, the most serious and aggressive form of skin cancer.[1] The worldwide incidence of melanoma is increasing more rapidly than any other form of cancer, and has shown an increase of about 4% per year in the United States.[1,2]