The skin lesion appears irregular in shape and color. Brown, black, and purple. The abnormality seems slightly raised above the surrounding normal-appearing skin.

Does he know about the skin lesion? Nadia Popovici, a young premedical student, types a message on her phone and knocks on the glass window to get his attention. He looks at the message, nods, smiles, and continues to work.

Only later does he get the news. Cancer. More specifically, skin melanoma.

Melanoma Basics

The American Cancer Society (ACS) explains that “melanoma is a skin cancer type that develops when melanocytes (the cells that give the skin its tan or brown color) begin to grow out of control.”

Melanoma is much less common than some other types of skin cancers. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not caught and treated early.

A risk factor raises your risk of getting a disease such as cancer. The ACS explains that several risk factors can make a person more likely to develop melanoma.

Ultraviolet light

Sunlight is the primary source of UV rays. Others included tanning beds and sun lamps. The pattern and timing of the exposure may play roles; for example, frequent sunburns (especially in childhood) can lead to melanoma on the chest and back.

Moles

Most moles never cause cancer, but those with many moles are more likely to develop melanoma.

Family history

Got a first-degree relative (parent, sister, brother, or child) with melanoma? Your risk is high of getting this skin cancer. Approximately ten percent of those with melanoma have a family history of the disease. Your risk of melanoma is also higher if you have a personal history of skin cancer (of any type). You should have regular skin exams by a dermatologist, examine your skin monthly, and be diligent about sun protection and avoiding tanning beds.

Other

Other risk factors for melanoma include race — Whites have a significantly higher risk than African Americans. Those with blond or red, blue or green eyes, or fair skin that freckles or burns quickly have a higher risk. Males have a higher risk of melanoma, as do older people (please note that it happens in young people, too).

Finally, the inherited condition Xeroderma Pigmentosum (XP) is a rare, inherited condition that affects skin cells’ ability to repair DNA damage. Individuals with XP have a high risk of getting melanoma and other skin cancers when they are young, especially in skin areas exposed to the sun.

Fast forward to this: Popovici and Hamilton in an emotional meeting. Our premedical student hero asks Hamilton, as both wear face masks if he is okay with shaking hands or hugging. An embrace soon follows, as does $10,000 (for medical school expenses) from the two hockey teams. Yes, this suicide crisis line worker just received several offers of admission to schools of medicine.

I want to end with some melanoma warning signs. Look for any new skin lesions, changing or unusual. Melanomas can arise anywhere, even where the sun does not shine. Fortunately, most moles, growths, and brown spots are harmless, but not always.

Melanoma symptoms and cancer detection

Use the ABCDEs and the Ugly Duckling sign to help yourself detect melanoma. The Skin Care Foundation reminds us of the warning signs of melanoma:

A is for Asymmetry. Most melanomas are asymmetrical. If you draw a line through the middle of the lesion, the two halves don’t match, so it looks different from a round to oval and symmetrical common mole.

B is for Border. Melanoma borders tend to be uneven and may have scalloped or notched edges, while common moles tend to have smoother, more even borders.

C is for Color. Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan, or black. As it grows, red, white, or blue may also appear.

D is for Diameter or Dark. While it’s ideal to detect a melanoma when it is small, it’s a warning sign if a lesion is the size of a pencil eraser (about 6 mm, or ¼ inch in diameter) or larger. Some experts say it is also essential to look for any lesion, no matter what size, that is darker than others. Rare, amelanotic melanomas are colorless.

E is for Evolving. Any change in size, shape, color, or elevation of a spot on your skin, or any new symptom in it, such as bleeding, itching, or crusting, may be a warning sign of melanoma.

Other warning signs include

• A non-healing sore
• Pigment spread from the border of a spot into the surrounding skin
• Redness or a new swelling beyond a mole’s border
• Change in sensation (for example, itchiness or tenderness)
• Change in a mole’s surface of a mole — scaliness, oozing, bleeding, or the appearance of a lump or bump

If you notice these warning signs or anything changing, new, or unusual on your skin, please promptly see a skin doctor (dermatologist).

The five-year survival rate for patients in the United States whose melanoma is detected early.

The survival rate drops to 66 percent if the disease reaches the lymph nodes and 27 percent if it spreads to distant organs. Immunotherapy is markedly improving the last number, but more on that later.

Melanoma pictures

My message today is: Look. And have someone check your back. If you have concerns, see a skin doctor soon. I am pleased that early-stage melanoma is associated with such an excellent prognosis. Recent immunotherapy advances have dramatically improved long-term survival odds on the other end of the spectrum.

Thank you for joining me today. Oh, Vancouver won 5 to 2 over my Seattle Kraken, but you and I both know the real winner.

The post Hockey Fan Spots Melanoma appeared first on Medika Life.

Do I think that the research is good enough to have our patients adopt the practice of a fasting-mimicking diet? No, the study does not conclude that such an approach to nutrition has antitumor effects. Let’s look at the study’s merits.

The study authors begin with this observation: In mice with cancer, cyclic fasting or fasting-mimicking diets (FMDs) enhance the activity of anti-cancer treatments by changing systemic metabolism and boosting anti-cancer immunity.

But what about humans? Can a similar dietary approach yield similar effects? To find out, researchers examined 101 patients undergoing treatment for either breast cancer or melanoma. They asked the study participants to do this:

Consume 1800 kilocalories in five days (more specifically, 600 on the first day and up to 300 kilocalories for the remaining four days). The subjects repeated the cycle every three to four weeks. The patients had no diet restrictions in-between cycles, but the investigators recommended a healthy diet and lifestyle.

Here are the results of an interim analysis of the ongoing DIgesT trial, testing a 5-day fasting-mimicking cycle seven to ten days before surgery.

First, dietary interventions (such as fasting) are often challenging for patients to follow. Not for this study: 92 percent complied with the diet approach.

The patients successfully modified both body and within-tumor metabolism and immune response with compliance high.

The average blood sugar concentrations dropped by 19 percent, and insulin levels dropped by 51 percent. Serum insulin-like growth factor-1 levels went down by 30 percent. These changes held over several dietary cycles.

I was concerned about body weight, but the weight loss appeared reversible during the healthy-eating periods between fasting cycles.

That’s a brief overview of this very recent study. It is only in abstract form, but I wanted to share it with you now. I love that the fasting-mimicking diet had a broad and favorable effect on immune system function. The diet approach led to many anti-cancer programs in the cancer cells.

I have recently been thinking more about out-of-the-box approaches for my patients at high risk for cancer-related recurrence or death. I am especially interested in approaches that modulate insulin-like growth factor-1 (IGF-1).

In summary, the new study reveals that a fasting-mimicking diet is associated with a significant rise in tumor-infiltrating CD8-positive T cells. This diet leads to an anti-cancer immune microenvironment at cancer cell and systemic levels.

Let’s close with the words of research team member Licia Rivoltini, MD, head of the immunotherapy of human tumors unit at the National Cancer Institute in Milan:

“Severe calorie restriction generated a metabolic shock that activated several populations of immune cells that could boost the antitumor activity of standard antineoplastic treatments.”

I look forward to seeing results from new clinical research, including the BREAKFAST trial. This experiment is the next step in understanding the anti-cancer effects caused by calorie restriction.

Oh, I cannot resist this shot of me in fabulous Milan:

Thank you for joining me today. I hope you have a joy-filled next year.

The post Fasting May Fight Cancer appeared first on Medika Life.

Fortunately, age-adjusted death rates are falling globally. Death rates show a 17 percent decline from 1990 to 2016. Today we look at some advances in the management of advanced breast and melanoma cancers that have spread to distant sites of the body.

Breast cancer

Let’s be clear: When breast cancer has spread to distant organs (such as the bones, lung, liver, or brain), the disease is not currently curable. What has me excited this morning is a recent report about long-term survival for two subtypes of breast cancer. Let’s get right to the results:

Patients with two of the three major types of advanced breast cancer now have a median overall survival of at least 5 years, which is roughly a doubling of survival time over the past decade.

The two types of advanced breast cancer for which survival times have doubled over the past decade are HER2-positive (HER2+) breast cancer and ER-positive (ER+) breast cancer. HER2-positive means that the cancer cells have a particular protein sticking out like antennae.

Individuals with HER2-positive disease represent about 25 percent of patients with metastatic breast cancer and now commonly live as long as ten years. Doctors can use drugs that target the HER2 pathway that drives cell growth and division. The best-known of these is trastuzumab (Herceptin).

For those of you who would like to hear more about Herceptin, try this book:

Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast CancerAmazon.com: Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer eBook: Bazell, Robert

To see a film representation of the passionate and inspiring story of Dr. Dennis Slamon, the UCLA (USA) doctor who helped develop the breast cancer drug, Herceptin, try this:

Living ProofTop-rated Lifetime movie! Dr. Dennis Slamon has reached a breakthrough in his career. He has helped to develop a new…

Melanoma

You may have heard about the revolutionary cancer management tool known as immunotherapy.

A group of investigators from around the world reported the results of using a combination of two immunotherapy drugs for advanced melanoma. Following treatment with nivolumab and ipilimumab drugs yielded a more prolonged progression-free survival and overall survival than with only one immunotherapy drug.

Striking to me are the long-term outcomes:

At a minimum follow-up of five years, the median overall survival was more than five years (median not yet reached) in the group that received two immunotherapy drugs in combination. Over half of patients with cancer spread to distant sites were still alive at the five-year mark.

Chronic disease survivors. Former United States President Jimmy Carter presented with advanced melanoma — his disease had spread to his brain. You know the rest of the story: First, doctors bombarded his cancer in the brain with a highly focused, high-dose radiation therapy known as radiosurgery.

The high-dose radiation therapy damaged the cancer cells in the brain. These dying cells then released substances into the bloodstream, attracting the attention of immune cells.

Carter then received immunotherapy; more specifically, he got a drug known as pembrolizumab (Keytruda). Three months after immunotherapy, the then-91-year old discovered that his tumors were gone. The drug supported his immune system’s response and appears to have completely eliminated any residual cancer.

More than five years later, President Carter has no evidence of cancer remaining. If you want to learn more about immunotherapy, please go here:

What is Immunotherapy?As of October 2021, the U.S.www.cancerresearch.org

You will not be surprised to learn that the 2018 Nobel Prize in Physiology or Medicine was awarded jointly to two cancer immunotherapy researchers, James P. Allison, Ph.D. of The University of Texas MD Anderson Cancer Center, and Dr. Tasuku Honjo of Kyoto University in Japan.

The Nobel Prize committee honored Allison and Honjo for their work on uncovering ways to activate the immune system to attack cancer.

Thank you for joining me today in exploring the promise of targeted therapy and immunotherapy in the management of advanced cancer.

The post Making Advanced Cancer a Chronic Disease appeared first on Medika Life.

Melanoma is a disease in which malignant cancer cells form in melanocytes (cells that color the skin)

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

• Squamous cells: Thin, flat cells that form the top layer of the epidermis.
• Basal cells: Round cells under the squamous cells.
• Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun or artificial light, melanocytes make more pigment and cause the skin to darken.

The number of new cases of melanoma has been increasing over the last 30 years. Melanoma is most common in adults, but it is sometimes found in children and adolescents. 

There are different types of cancer that start in the skin.

There are two main forms of skin cancer: melanoma and nonmelanoma.

Melanoma is a rare form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). This article is about cutaneous (skin) melanoma and melanoma that affects the mucous membranes.

The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body.

Melanoma can occur anywhere on the skin.

In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma forms most often on the arms and legs.

When melanoma occurs in the eye, it is called intraocular or ocular melanoma.

Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for melanoma include the following:

• Having a fair complexion, which includes the following:
  • Fair skin that freckles and burns easily, does not tan, or tans poorly.
  • Blue or green or other light-colored eyes.
  • Red or blond hair.
• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds).
• Being exposed to certain factors in the environment (in the air, your home or workplace, and your food and water). Some of the environmental risk factors for melanoma are radiation, solvents, vinyl chloride, and PCBs.
• Having a history of many blistering sunburns, especially as a child or teenager.
• Having several large or many small moles.
• Having a family history of unusual moles (atypical nevus syndrome).
• Having a family or personal history of melanoma.
• Being white.
• Having a weakened immune system.
• Having certain changes in the genes that are linked to melanoma.

Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.

Signs of melanoma include a change in the way a mole or pigmented area looks.

These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have any of the following:

• A mole that:
  • changes in size, shape, or color.
  • has irregular edges or borders.
  • is more than one color.
  • is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
  • itches.
  • oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through).
• A change in pigmented (colored) skin.
• Satellite moles (new moles that grow near an existing mole).

Tests that examine the skin are used to diagnose melanoma.

If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help find and diagnose melanoma:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Skin exam: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
• Biopsy: A procedure to remove the abnormal tissue and a small amount of normal tissue around it. A pathologist looks at the tissue under a microscope to check for cancer cells. It can be hard to tell the difference between a colored mole and an early melanoma lesion. Patients may want to have the sample of tissue checked by a second pathologist. If the abnormal mole or lesion is cancer, the sample of tissue may also be tested for certain gene changes.There are four main types of skin biopsies. The type of biopsy done depends on where the abnormal area formed and the size of the area.
  • Shave biopsy: A sterile razor blade is used to “shave-off” the abnormal-looking growth.
  • Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth.

• • Incisional biopsy: A scalpel is used to remove part of a growth.
  • Excisional biopsy: A scalpel is used to remove the entire growth.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

• The thickness of the tumor and where it is in the body.
• How quickly the cancer cells are dividing.
• Whether there was bleeding or ulceration of the tumor.
• How much cancer is in the lymph nodes.
• The number of places cancer has spread to in the body.
• The level of lactate dehydrogenase (LDH) in the blood.
• Whether the cancer has certain mutations (changes) in a gene called BRAF.
• The patient’s age and general health.

Stages of Melanoma

After melanoma has been diagnosed, tests may be done to find out if cancer cells have spread within the skin or to other parts of the body.

The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

For melanoma that is not likely to spread to other parts of the body or recur, more tests may not be needed. For melanoma that is likely to spread to other parts of the body or recur, the following tests and procedures may be done after surgery to remove the melanoma:

• Lymph node mapping and sentinel lymph node biopsy: The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor. It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma, pictures may be taken of the neck, chest, abdomen, and pelvis.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues, such as lymph nodes, or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH). High LDH levels may predict a poor response to treatment in patients with metastatic disease.

The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if melanoma spreads to the lung, the cancer cells in the lung are actually melanoma cells. The disease is metastatic melanoma, not lung cancer.

The stage of melanoma depends on the thickness of the tumor, whether cancer has spread to lymph nodes or other parts of the body, and other factors.

To find out the stage of melanoma, the tumor is completely removed and nearby lymph nodes are checked for signs of cancer. The stage of the cancer is used to determine which treatment is best. Check with your doctor to find out which stage of cancer you have.

The stage of melanoma depends on the following:

The thickness of the tumor. The thickness of the tumor is measured from the surface of the skin to the deepest part of the tumor.

Whether the tumor is ulcerated (has broken through the skin).

Whether cancer is found in lymph nodes by a physical exam, imaging tests, or a sentinel lymph node biopsy

Whether the lymph nodes are matted (joined together).

Whether there are:

• Satellite tumors: Small groups of tumor cells that have spread within 2 centimeters of the primary tumor.
• Microsatellite tumors: Small groups of tumor cells that have spread to an area right beside or below the primary tumor.
• In-transit metastases: Tumors that have spread to lymph vessels in the skin more than 2 centimeters away from the primary tumor, but not to the lymph nodes.

Whether the cancer has spread to other parts of the body, such as the lung, liver, brain, soft tissue (including muscle), gastrointestinal tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first formed.

The following stages are used for melanoma:

Stage 0 (Melanoma in Situ)

In stage 0, abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

• Stage IA: The tumor is not more than 1 millimeter thick, with or without ulceration.
• Stage IB: The tumor is more than 1 but not more than 2 millimeters thick, without ulceration.

Stage II

Stage II is divided into stages IIA, IIB, and IIC.

Stage IIA: The tumor is either:

• more than 1 but not more than 2 millimeters thick, with ulceration; or
• more than 2 but not more than 4 millimeters thick, without ulceration.

Stage IIB: The tumor is either:

• more than 2 but not more than 4 millimeters thick, with ulceration; or
• more than 4 millimeters thick, without ulceration.

Stage IIC: The tumor is more than 4 millimeters thick, with ulceration.

Stage III

Stage III is divided into stages IIIA, IIIB, IIIC, and IIID.

• Stage IIIA: The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration. Cancer is found in 1 to 3 lymph nodes by sentinel lymph node biopsy.
• Stage IIIB:
  • (1) It is not known where the cancer began or the primary tumor can no longer be seen, and one of the following is true:
    • cancer is found in 1 lymph node by physical exam or imaging tests; or
    • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.or
  • (2) The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration, and one of the following is true:
    • cancer is found in 1 to 3 lymph nodes by physical exam or imaging tests; or
    • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.or
  • (3) The tumor is more than 1 but not more than 2 millimeters thick, with ulceration, or more than 2 but not more than 4 millimeters thick, without ulceration, and one of the following is true:
    • cancer is found in 1 to 3 lymph nodes; or
    • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
• Stage IIIC:
  • (1) It is not known where the cancer began, or the primary tumor can no longer be seen. Cancer is found:
    • in 2 or 3 lymph nodes; or
    • in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
    • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
    • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.or
  • (2) The tumor is not more than 2 millimeters thick, with or without ulceration, or not more than 4 millimeters thick, without ulceration. Cancer is found:
    • in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
    • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
    • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.or
  • (3) The tumor is more than 2 but not more than 4 millimeters thick, with ulceration, or more than 4 millimeters thick, without ulceration. Cancer is found in 1 or more lymph nodes and/or in any number of lymph nodes that are matted together. There may be microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.or
  • (4) The tumor is more than 4 millimeters thick, with ulceration. Cancer is found in 1 or more lymph nodes and/or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
• Stage IIID: The tumor is more than 4 millimeters thick, with ulceration. Cancer is found:
  • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
  • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

Stage IV

In stage IV, the cancer has spread to other parts of the body, such as the lung, liver, brain, spinal cord, bone, soft tissue (including muscle), gastrointestinal (GI) tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first started.

Melanoma can recur (come back) after it has been treated.

The cancer may come back in the area where it first started or in other parts of the body, such as the lungs or liver.

There are different types of treatment for patients with melanoma.

Different types of treatment are available for patients with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Five types of standard treatment are used:

Surgery

Surgery to remove the tumor is the primary treatment of all stages of melanoma. A wide local excision is used to remove the melanoma and some of the normal tissue around it. Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.

Sometimes, it is important to know whether cancer has spread to the lymph nodes. Lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the sentinel lymph node (the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor). It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, more lymph nodes will be removed and tissue samples will be checked for signs of cancer. This is called a lymphadenectomy. Sometimes, a sentinel lymph node is found in more than one group of nodes.

After the doctor removes all the melanoma that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after the surgery, to lower the risk that the cancer will come back, is called therapy.

Surgery to remove cancer that has spread to the lymph nodes, lung, gastrointestinal (GI) tract, bone, or brain may be done to improve the patient’s quality of life by controlling symptoms.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

One type of regional chemotherapy is hyperthermic isolated limb perfusion. With this method, anticancer drugs go directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drug is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy is used to treat melanoma and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

The following types of immunotherapy are being used in the treatment of melanoma:

• Immune checkpoint inhibitor therapy: Some types of immune cells, such as T cells, and some cancer cells have certain proteins, called checkpoint proteins, on their surface that keep immune responses in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased. They are used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery.There are two types of immune checkpoint inhibitor therapy:
  • CTLA-4 inhibitor: CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells. Ipilimumab is a type of CTLA-4 inhibitor.

PD-1 inhibitor: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. Pembrolizumab and nivolumab are types of PD-1 inhibitors.

• Interleukin-2 (IL-2): IL-2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.
• Tumor necrosis factor (TNF) therapy: TNF is a protein made by white blood cells in response to an antigen or infection. TNF is made in the laboratory and used as a treatment to kill cancer cells. It is being studied in the treatment of melanoma.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following types of targeted therapy are used or being studied in the treatment of melanoma:

• Signal transduction inhibitor therapy: Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. They are used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery. Signal transduction inhibitors include:
  • BRAF inhibitors (dabrafenib, vemurafenib, encorafenib) that block the activity of proteins made by mutant BRAF genes; and
  • MEK inhibitors (trametinib, cobimetinib, binimetinib) that block proteins called MEK1 and MEK2 which affect the growth and survival of cancer cells.Combinations of BRAF inhibitors and MEK inhibitors used to treat melanoma include:
  • Dabrafenib plus trametinib.
  • Vemurafenib plus cobimetinib.
  • Encorafenib plus binimetinib.
• Oncolytic virus therapy: A type of targeted therapy that is used in the treatment of melanoma. Oncolytic virus therapy uses a virus that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells. Talimogene laherparepvec is a type of oncolytic virus therapy made with a form of the herpesvirus that has been changed in the laboratory. It is injected directly into tumors in the skin and lymph nodes.
• Angiogenesis inhibitors: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new blood vessels. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow.

New targeted therapies and combinations of therapies are being studied in the treatment of melanoma.

Vaccine therapy

Vaccine therapy is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. Vaccine therapy is being studied in the treatment of stage III melanoma that can be removed by surgery.

Treatment of Stage 0 (Melanoma in Situ)

Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it.

Treatment of Stage I Melanoma

Treatment of stage I melanoma may include the following:

• Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and removal of lymph nodes is also done.
• A clinical trial of new ways to find cancer cells in the lymph nodes.

Treatment of Stage II Melanoma

Treatment of stage II melanoma may include the following:

• Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
• A clinical trial of new types of treatment to be used after surgery.

Treatment of Stage III Melanoma That Can Be Removed By Surgery

Treatment of stage III melanoma that can be removed by surgery may include the following:

• Surgery to remove the tumor and some of the normal tissue around it. Skin grafting may be done to cover the wound caused by surgery. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
• Surgery followed by immunotherapy with immune checkpoint inhibitors (nivolumab, pembrolizumab, or ipilimumab) if there is a high risk that the cancer will come back.
• Surgery followed by targeted therapy with signal transduction inhibitors (dabrafenib and trametinib) if there is a high risk that the cancer will come back.
• A clinical trial of immunotherapy with or without vaccine therapy.
• A clinical trial of surgery followed by therapies that target specific gene changes.

Use the clinical trial search [NCI Website] to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information [NCI Websites] about clinical trials is also available.

Treatment of Stage III Melanoma That Cannot Be Removed By Surgery, Stage IV Melanoma, and Recurrent Melanoma

Treatment of stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma may include the following:

• Oncolytic virus therapy (talimogene laherparepvec) injected into the tumor.
• Immunotherapy with ipilimumab, pembrolizumab, nivolumab, or interleukin-2 (IL-2). Sometimes ipilimumab and nivolumab are given together.
• Targeted therapy with signal transduction inhibitors (dabrafenib, trametinib, vemurafenib, cobimetinib, encorafenib, binimetinib). These may be given alone or in combination.
• Chemotherapy.
• Palliative therapy to relieve symptoms and improve the quality of life. This may include:
  • Surgery to remove lymph nodes or tumors in the lung, gastrointestinal (GI) tract, bone, or brain.
  • Radiation therapy to the brain, spinal cord, or bone.

Treatments that are being studied in clinical trials for stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma include the following:

• Immunotherapy alone or in combination with other therapies such as targeted therapy.
• For melanoma that has spread to the brain, immunotherapy with nivolumab plus ipilimumab.
• Targeted therapy, such as signal transduction inhibitors, angiogenesis inhibitors, oncolytic virus therapy, or drugs that target certain gene mutations. These may be given alone or in combination.
• Surgery to remove all known cancer.
• Regional chemotherapy (hyperthermic isolated limb perfusion). Some patients may also have immunotherapy with tumor necrosis factor.
• Systemic chemotherapy.

The post Melanoma, a skin cancer appeared first on Medika Life.

• Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.
• Different types of cancer start in the skin.
• Skin color and being exposed to sunlight can increase the risk of basal cell carcinoma and squamous cell carcinoma of the skin.
• Basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis often appear as a change in the skin.
• Tests or procedures that examine the skin are used to diagnose basal cell carcinoma and squamous cell carcinoma of the skin.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Skin cancer is the most common cancer in the United States.

Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer in the United States. The number of new cases of nonmelanoma skin cancer appears to be increasing every year. These nonmelanoma skin cancers can usually be cured.

The number of new cases of melanoma has been increasing for at least 30 years. Melanoma is more likely to spread to nearby tissues and other parts of the body and can be harder to cure. Finding and treating melanoma skin cancer early may help prevent death from melanoma.

Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

• Squamous cells: Thin, flat cells that form the top layer of the epidermis.
• Basal cells: Round cells under the squamous cells.
• Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken

Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, and hands.

Different types of cancer start in the skin.

Skin cancer may form in basal cells or squamous cells. Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. They are also called nonmelanoma skin cancer. Actinic keratosis is a skin condition that sometimes becomes squamous cell carcinoma.

Melanoma is less common than basal cell carcinoma or squamous cell carcinoma. It is more likely to invade nearby tissues and spread to other parts of the body.

This summary is about basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis.

• Melanoma Treatment
• Mycosis Fungoides (Including Sézary Syndrome) Treatment
• Kaposi Sarcoma Treatment
• Merkel Cell Carcinoma Treatment
• Childhood Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin Treatment
• Genetics of Skin Cancer

Skin color and being exposed to sunlight can increase the risk of basal cell carcinoma and squamous cell carcinoma of the skin.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for basal cell carcinoma and squamous cell carcinoma of the skin include the following:

• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
• Having a fair complexion, which includes the following:
  • Fair skin that freckles and burns easily, does not tan, or tans poorly.
  • Blue, green, or other light-colored eyes.
  • Red or blond hair.Although having a fair complexion is a risk factor for skin cancer, people of all skin colors can get skin cancer.
• Having a history of sunburns.
• Having a personal or family history of basal cell carcinoma, squamous cell carcinoma of the skin, actinic keratosis, familial dysplastic nevus syndrome, or unusual moles.
• Having certain changes in the genes or hereditary syndromes, such as basal cell nevus syndrome, that are linked to skin cancer.
• Having skin inflammation that has lasted for long periods of time.
• Having a weakened immune system.
• Being exposed to arsenic.
• Past treatment with radiation.

Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

Basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis often appear as a change in the skin.

Not all changes in the skin are a sign of basal cell carcinoma, squamous cell carcinoma of the skin, or actinic keratosis. Check with your doctor if you notice any changes in your skin.

Signs of basal cell carcinoma and squamous cell carcinoma of the skin include the following:

• A sore that does not heal.
• Areas of the skin that are:
  • Raised, smooth, shiny, and look pearly.
  • Firm and look like a scar, and may be white, yellow, or waxy.
  • Raised and red or reddish-brown.
  • Scaly, bleeding, or crusty.

Basal cell carcinoma and squamous cell carcinoma of the skin occur most often in areas of the skin exposed to the sun, such as the nose, ears, lower lip, or top of the hands.

Signs of actinic keratosis include the following:

• A rough, red, pink, or brown, scaly patch on the skin that may be flat or raised.
• Cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.

Actinic keratosis occurs most commonly on the face or the top of the hands.

Tests or procedures that examine the skin are used to diagnose basal cell carcinoma and squamous cell carcinoma of the skin.

The following procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Skin exam: An exam of the skin for bumps or spots that look abnormal in color, size, shape, or texture.
• Skin biopsy: All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are four main types of skin biopsies:
  • Shave biopsy: A sterile razor blade is used to “shave-off” the abnormal-looking growth.
  • Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth.

• • Incisional biopsy: A scalpel is used to remove part of a growth.
  • Excisional biopsy: A scalpel is used to remove the entire growth.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis for squamous cell carcinoma of the skin depends mostly on the following:

• Stage of the cancer.
• Whether the patient is immunosuppressed.
• Whether the patient uses tobacco.
• The patient’s general health.

Treatment options for basal cell carcinoma and squamous cell carcinoma of the skin depend on the following:

• The type of cancer.
• The stage of the cancer, for squamous cell carcinoma.
• The size of the tumor and what part of the body it affects.
• The patient’s general health.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if skin cancer spreads to the lung, the cancer cells in the lung are actually skin cancer cells. The disease is metastatic skin cancer, not lung cancer.

Avoiding risk factors and increasing protective factors may help prevent cancer.

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

Being exposed to ultraviolet radiation is a risk factor for skin cancer.

Some studies suggest that being exposed to ultraviolet (UV) radiation and the sensitivity of a person’s skin to UV radiation are risk factors for skin cancer. UV radiation is the name for the invisible rays that are part of the energy that comes from the sun. Sunlamps and tanning beds also give off UV radiation.

Risk factors for nonmelanoma and melanoma cancers are not the same.

• Risk factors for nonmelanoma skin cancer:
  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
  • Having a fair complexion, which includes the following:
    • Fair skin that freckles and burns easily, does not tan, or tans poorly.
    • Blue or green or other light-colored eyes.
    • Red or blond hair.
  • Having actinic keratosis.
  • Past treatment with radiation.
  • Having a weakened immune system.
  • Being exposed to arsenic.
• Risk factors for melanoma skin cancer:
  • Having a fair complexion, which includes the following:
    • Fair skin that freckles and burns easily, does not tan, or tans poorly.
    • Blue or green or other light-colored eyes.
    • Red or blond hair.
  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
  • Having a history of many blistering sunburns, especially as a child or teenager.
  • Having several large or many small moles.
  • Having a family history of unusual moles (atypical nevus syndrome).
  • Having a family or personal history of melanoma.
  • Being white.

Although having a fair complexion is a risk factor for nonmelanoma and melanoma skin cancer, people of all skin colors can get skin cancer.

It is not known if the following lower the risk of nonmelanoma skin cancer:

Sunscreen use and avoiding sun exposure

It is not known if nonmelanoma skin cancer risk is decreased by staying out of the sun, using sunscreens, or wearing protective clothing when outdoors. This is because not enough studies have been done to prove this.

Sunscreen may help decrease the amount of UV radiation to the skin. One study found that wearing sunscreen can help prevent actinic keratoses, scaly patches of skin that sometimes become squamous cell carcinoma.

The harms of using sunscreen are likely to be small and include allergic reactions to skin creams and lower levels of vitamin D made in the skin because of less sun exposure.

It is also possible that when a person uses sunscreen to avoid sunburn they may spend too much time in the sun and be exposed to harmful UV radiation.

Although protecting the skin and eyes from the sun has not been proven to lower the chance of getting skin cancer, skin experts suggest the following:

• Use sunscreen that protects against UV radiation.
• Do not stay out in the sun for long periods of time, especially when the sun is at its strongest.
• Wear long sleeve shirts, long pants, sun hats, and sunglasses, when outdoors.

Chemopreventive agents

Chemoprevention is the use of drugs, vitamins, or other agents to try to reduce the risk of cancer. The following chemopreventive agents have been studied to find whether they lower the risk of nonmelanoma skin cancer:

Beta carotene

Studies of beta carotene (taken as a supplement in pills) have not shown that it prevents nonmelanoma skin cancer from forming or coming back.

Isotretinoin

High doses of isotretinoin have been shown to prevent new skin cancers in patients with xeroderma pigmentosum. However, isotretinoin has not been shown to prevent nonmelanoma skin cancers from coming back in patients previously treated for nonmelanoma skin cancers. Treatment with isotretinoin can cause serious side effects.

Selenium

Studies have shown that selenium (taken in brewer’s yeast tablets) does not lower the risk of basal cell carcinoma, and may increase the risk of squamous cell carcinoma.

Celecoxib

A study of celecoxib in patients with actinic keratosis and a history of nonmelanoma skin cancer found those who took celecoxib had slightly lower rates of recurrent nonmelanoma skin cancers. Celecoxib may have serious side effects on the heart and blood vessels.

Alpha-difluoromethylornithine (DFMO)

A study of alpha-difluoromethylornithine (DFMO) in patients with a history of nonmelanoma skin cancer showed that those who took DFMO had lower rates of nonmelanoma skin cancers coming back than those who took a placebo. DFMO may cause hearing loss which is usually temporary.

Nicotinamide (vitamin B3)

Studies have shown that nicotinamide (vitamin B3) helps prevent new actinic keratoses lesions from forming in people who had four or fewer actinic lesions before taking nicotinamide. More studies are needed to find out if nicotinamide prevents nonmelanoma skin cancer from forming or coming back.

It is not known if the following lower the risk of melanoma:

Sunscreen

It has not been proven that using sunscreen to prevent sunburn can protect against melanoma caused by UV radiation. Other risk factors such as having skin that burns easily, having a large number of benign moles, or having atypical nevi may also play a role in whether melanoma forms.

Expanded information on the different types of skin cancer

Medika has reproduced the following NCI sourced information for your convenience. We recommend visiting the NCI for any additional information and resources. Open the appropriate NCI page by clicking on listed source below the article.

• Squamous cell carcinoma, a skin cancer
• Basal cell carcinoma, a skin cancer
• Melanoma, a skin cancer

The post Skin Cancer, an overview appeared first on Medika Life.